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Measuring Organizational Sponsorship Credibility: The Application of Source Credibility Theory in Determining the Most Effective Advocacy Advertisement Sponsor

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Measuring Organizational Sponsorship Credibility: The Application of Source Credibility Theory in Determining the Most Effective Advocacy Advertisement Sponsor
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BALLENTINE, AMANDA J. ( Author, Primary )
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2008

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Advertising research ( jstor )
Advocacy ( jstor )
Community associations ( jstor )
Consumer advertising ( jstor )
Drug prescriptions ( jstor )
Institutional advertising ( jstor )
Marketing ( jstor )
Medications ( jstor )
Pharmacists ( jstor )
Sponsorship ( jstor )

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University of Florida
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University of Florida
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Copyright Amanda J. Ballentine. Permission granted to the University of Florida to digitize, archive and distribute this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.
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8/31/2007

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MEASURING ORGANIZATIONAL SPONSORSHIP CREDIBILITY: THE APPLICATION OF SOURCE CREDIBILITY THEORY IN DET ERMINING THE MOST EFFECTIVE ADVOCACY ADVERTISEMENT SPONSOR By AMANDA J. BALLENTINE A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 2006

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Copyright 2006 by Amanda J. Ballentine

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For Keith, nothing else matters.

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iv ACKNOWLEDGMENTS I would like to acknowledge my husband who is a con stant source of support and comic relief. I also offer special thanks to my par ents who have fostered my love of learning. Additionally, I appreciate the time and effort expe nded by my mentor and chairperson, Earlene Lipowski, and my dissertation committee members Carole Kimberlin, David Brushwood, and Craig Velozo. Witho ut their wisdom and guidance, this document would not have come to fruition. This project was funded in part by the Perry A. Foo te Small Grants Program.

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v TABLE OF CONTENTS page ACKNOWLEDGMENTS.................................... ................................................... ..........iv LIST OF TABLES..................................... ................................................... ....................vii LIST OF FIGURES.................................... ................................................... ..................viii ABSTRACT........................................... ................................................... ..........................x CHAPTER 1 INTRODUCTION..................................... ................................................... ................1 Importation Background............................. ................................................... ...............2 Advocacy Advertising Background.................... ................................................... .......3 2 THEORETICAL FRAMEWORK............................ ................................................... .5 3 LITERATURE REVIEW................................ ................................................... ..........9 4 METHODS.......................................... ................................................... ....................15 Instrument Development............................. ................................................... ............15 Subjects........................................... ................................................... ..................15 Measure............................................ ................................................... ................16 Instrument Application............................. ................................................... ...............28 Subjects........................................... ................................................... ..................29 Analysis Plan...................................... ................................................... ..............29 5 INSTRUMENT DEVELOPMENT RESULTS................... .......................................31 Rating Scale Performance........................... ................................................... .............33 Construct Unidimensionality (Item Fit)............. ................................................... ......36 Construct Validity (Item Hierarchy)................ ................................................... ........38 Person Fit......................................... ................................................... ........................39 Credibility Scale Revision......................... ................................................... ..............41 Performance........................................ ................................................... ..............41 Structure.......................................... ................................................... .................43

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vi 6 INSTRUMENT APPLICATION RESULTS................... ..........................................47 Credibility Scale Performance...................... ................................................... ...........49 Analysis of Variance............................... ................................................... .................56 7 DISCUSSION....................................... ................................................... ...................59 Instrument Development............................. ................................................... ............59 Instrument Application............................. ................................................... ...............61 Limitations........................................ ................................................... .......................62 Implications....................................... ................................................... ......................63 APPENDIX A INSTRUMENT DEVELOPMENT SURVEY TRANSCRIPT......... .........................64 B INSTRUMENT APPLICATION SURVEY TRANSCRIPT......... ............................69 LIST OF REFERENCES................................. ................................................... ...............76 BIOGRAPHICAL SKETCH................................ ................................................... ..........79

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vii LIST OF TABLES Table page 3-1 Haley’s credibility descriptors from interview transcripts.......................................12 4-1 Item generation from credibility components........ ..................................................1 7 4-2 Organizational sponsorship credibility item develop ment.......................................19 4-3 Pilot test respondent demographics................. ................................................... ......24 4-4 Hypothesized item hierarchy from most difficult to easiest to endorse...................27 5-1 Descriptive statistics for the instrument developme nt sample.................................32 5-2 Four-point rating scale analysis................... ................................................... ..........35 5-3 Summary statistics of the thirty-two item instrumen t..............................................36 5-4 Item calibrations and correlations from most diffic ult to easiest to endorse............37 5-5 Item calibration and correlations for the revised c redibility scale...........................41 5-6 Summary statistics of the twelve item instrument... ................................................42 5-7 Sponsorship credibility instrument in relation to H aley’s relationship triad............43 5-8 Credibility items and rotated factor loadings...... ................................................... ..45 6-1 Descriptive statistics for the instrument applicati on sample....................................48 6-2 Likelihood of believing advocacy advertisement cont ent........................................49 6-3 Mean person measures............................... ................................................... ...........50 6-4 Item measure order................................. ................................................... ...............51 6-5 Anchored mean person measures...................... ................................................... ....56 6-6One-way repeated measures analysis of variance....................................................57 6-7Pairwise comparison of means.................................................................................57

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viii LIST OF FIGURES Figure page 2-1 Relationship between source credibility and consume r attitudes...............................5 2-2 Relationship between advertisement types and messag e sources..............................8 3-1 Haley’s triadic depiction of consumer understanding s of advocacy messages........11 5-1 Probability of responses for each of the six rating s.................................................3 4 5-2 Probability of responses for each of the four ratin gs...............................................34 5-3 Relationship between person ability and item diffic ulty..........................................40 5-4 Scree test for the factor structure................ ................................................... ...........44 6-1 Differential item functioning across organizational sponsors..................................53 6-2 Differential item functioning across administration s...............................................55

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ix Abstract of Dissertation Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy MEASURING ORGANIZATIONAL SPONSORSHIP CREDIBILITY: THE APPLICATION OF SOURCE CREDIBILITY THEORY IN DET ERMINING THE MOST EFFECTIVE ADVOCACY ADVERTISEMENT SPONSOR By Amanda J. Ballentine August 2006 Chair: Earlene E. Lipowski Major Department: Pharmacy Health Care Administrati on Background: In marketing and advertising research, spokesperson and corporate source credibility has been studied as a predictor and outcome variable in tangible goods and service advertising. However, no scales have be en developed to measure organizational source credibility in advocacy adver tising. Objectives: The research objectives were to develop an organizational sponsorship credibility scale in the context of advocacy advert isements and determine which sponsor (the government, pharmaceutical manufacturers, or p harmacists) is perceived to be the most credible for a prescription medication anti-im portation campaign. Methods: Rasch measurement, the one-parameter itemresponse theory model, was used to create a difficulty-ordered equal interval organizational sponsorship credibility scale. The 12-item scale was administered to the ge neral Florida population (N=150) via telephone. Respondents were asked to assess the cre dibility of each of the three potential

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x advertisement sponsors. One-way repeated measures a nalysis of variance was used to compare the three mean measures of credibility. Results: When directly queried, the respondents fel t the government, represented by the U.S. Food and Drug Administration (FDA), was the most appropriate sponsor for an anti-importation campaign and that the pharmacis ts were the most credible. Over 80 percent were somewhat or very likely to believe the information in an advertisement sponsored by the FDA or the pharmacists. The mean m easure of perceived sponsorship credibility was the highest for the pharmacists, fo llowed by the FDA, and then the pharmaceutical manufacturers. The validity checks s upported the empirical findings. Conclusion: The sponsorship credibility scale captu res and quantifies the credibility construct. In addition to benefiting advocacy campa ign development by providing a tool to model other sponsorship evaluations, the current research contributes to the communication and marketing disciplines by enhancin g credibility construct definition and source credibility theory.

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1 CHAPTER 1 INTRODUCTION The National Association of Boards of Pharmacy (NAB P) discussed complaint reports in a 2003 position paper on the importation of foreign prescription drugs (NABP, 2003). The reports describe incidents in which consumer s received counterfeit products, inappropriately packaged products (e.g., loose pill s in sandwich baggies), products in a similar class but not the drug requested (e.g., Zol oft instead of Paxil), and incorrect medication altogether (e.g., lisinopril instead of tamoxifen). Additionally, consumers have reported being charged for medication never re ceived and consuming duplicate therapy due to name differences between foreign and domestic drug products. Despite these reports, political leaders and the Am erican public dismiss the contention that imports pose a significant health r isk to American consumers and favor importation as a solution to high prices. An August 2003 survey conducted by the Kaiser Family Foundation and Harvard School of Public Heal th found that when given pro (importation will lower prices) and con (importatio n will lead to unsafe drugs entering the country) arguments, 63 percent of the public an d 57 percent of seniors continued to express support for importation of prescription dru gs (Kaiser, 2003). To warn consumers of the risks associated with pres cription drug importation, government agencies, pharmaceutical industry, and p rofessional groups have launched anti-importation advertising campaigns. Both public and private dollars are being spent to fund the campaigns; however, no action has been tak en to determine if the campaigns are effective and the money well-spent.

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2 An essential element in persuasion and effective ad vertising is credibility. The proposed research will address the measurement of t he perception of advertisement sponsorship credibility in the context of anti-impo rtation advocacy advertising. The specific aim is to determine which campaign sponsor (a federal agency, a pharmaceutical company, or a pharmacist organization) is perceived to be the most credible choice for an anti-importation campaign. Importation Background According to the National Health Statistics Group, 10.7 percent of national health expenditures resulted from prescription medications in 2003 (Centers for Medicare and Medicaid Services, 2005). Additionally, the Medical Expenditure Panel Surv ey reported total expenditures for outpatient prescription drug s increased 40 percent from $72.3 billion in 1997 to $103 billion in 2000. Every year during this period, those 65 years and older averaged out-of-pocket expenses for prescript ion medications that were more than three times higher than the expenses for those unde r 65 years of age (Agency for Healthcare Research and Quality, 2004). These statistics highlight major issues in healthcare today: an increasing proportion of the h ealthcare dollar is being spent on prescription drugs, these medications are costly, a nd the elderly are paying more for prescription medications than the general adult pop ulation. These trends have fueled the debate surrounding the public health issue of presc ription drug importation. A price differential exists between prescription me dications available in the U.S. and other countries. The differential is mainly a r esult of dissimilar government structures and regulations. For example, Canada has universal health insurance coverage and national price caps set by the Patented Medicines P rices Review Board—an independent quasi-judicial body that protects consumer interest s by regulating manufacturer’s prices

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3 of patented drugs to ensure that they are not exces sive (PMPRB, 2003). Foreign prescription drug prices become even more attractiv e to American consumers given the favorable exchange rate of the U.S. Dollar in Canad a and Mexico. To take advantage of the differential, American con sumers are turning to foreign countries for pharmacy services and price relief by traveling to pharmacies in Canada or Mexico, ordering from foreign internet pharmacies, or becoming clients of local storefront pharmacies that serve as liaisons betwee n the patient-consumer and the foreign pharmacy. According to the U.S. Food and Drug Admin istration (FDA), all of these actions increase the likelihood that Americans are receiving counterfeit, super-potent, sub-potent, contaminated, or inappropriate products (Meadows, 2002). Advertising campaigns, with print, radio, and telev ision advertisements, have been developed to counter the tide of importation. These advertisements are part of a public health social marketing campaign designed to stop i mportation and protect American consumers. The campaigns are supported by many orga nizations including pharmaceutical manufacturers, professional pharmacy organizations, and the FDA. With such diverse support, advertisement credibility and effectiveness could be influenced by the individual sponsor. For example, the credibilit y of the pharmaceutical manufacturer sponsor could be diminished by perceived financial ulterior motives, and professional pharmacy organization sponsorship could likewise be perceived as self-serving. Advocacy Advertising Background Social marketing refers to the marketing of possibl e solutions to social and health problems and encourages people to modify their beha vior as a means of enhancing their lives and society in general. Kotler and Zaltman (1971), in their article “Social Marketing: An Approach to Planned Social Change,” d efined social marketing to include:

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4 the design, implementation, and control of programs calculated to influence the acceptability of social ideas and involving conside rations of product planning, pricing, communication, distribution, and marketing research. Advocacy advertising is a social marketing tool. Ex amples include advertisements designed to increase HIV awareness and testing, pro mote smoking cessation and condom use, prevent drug abuse and teenage pregnancy, enco urage seatbelt use and speed limit adherence, and discourage drug importation. Advocac y advertisements present information or a point-of-view on a controversial p ublic issue, idea, or cause with the objective of changing consumer perceptions and/or b ehavior. Credibility is critical to any form of persuasive c ommunication, especially advertising. For effectiveness, both the endorser o f the product or issue (i.e., the spokesperson) and the company or organization behin d the message (i.e., the sponsor) must be perceived as credible by the consumer or ta rget audience. The proposed investigation is concerned with consumer perception s of sponsorship credibility. If the most appropriate sponsor for an advocacy advertisem ent could be determined, message credibility could be enhanced to produce persuasive and effective campaigns.

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5 CHAPTER 2 THEORETICAL FRAMEWORK Source credibility theory is a component of the com munication psychology field of persuasion. According to Hovland, Janis, and Kelley (1953), people are more likely to be persuaded when the source is perceived to be credib le. As a psychological construct, credibility historically involved communicator expe rtise, trustworthiness, attractiveness, and power (Underwood, 2003; Petty & Cacioppo, 1981). Figure 2-1 Relationship between source credibility and consumer attitudes Carl Hovland, noted psychologist and theorist, esta blished the original source credibility framework in the early 1950s (Hovland, 1953; Lane, 2001). Hovland, Janis, and Kelley (1953) published communicator credibility studies in a b ook entitled “Communication and Persuasion: Psychological Studie s of Opinion Change.” The focus of the text was not to develop a systematic theory of persuasion or opinion change, but to highlight issues which must be considered in constr ucting a general science of communication. Source Credibility Expertise Trustworthiness Attractiveness Power Attitude toward the Action Attitude toward the advertisement

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6 The research studies conducted by the Hovland group were concerned with the factors related to credibility of the message sourc e in the context of mass communication. The source was defined as the person or group perce ived as originating the communication. Communicator expertise and trustwort hiness were manipulated to measure the credibility effects on the perception a nd evaluation of the message content and presentation and the degree of attitude and bel ief modification. Expertise was defined as the extent to which a comm unicator is perceived to be knowledgeable and a source of valid assertions (e.g ., communicator knowledge and ability), and trustworthiness was described as the degree of confidence in the communicator’s intent to convey the most valid asse rtions (e.g., communicator honesty and believability). Additional components of credibility were not menti oned by Hovland et al., but were studied by other researchers in later years to assess their effects on attitudes and behaviors. Attractiveness is defined as perceived p hysical attractiveness, similarity, familiarity, and/or likeability of the communicator . Chaiken (1979) published seminal work on the persuasive effects of attractiveness. S he found that college students were more likely to agree with (attitude effect) and sig n an issue petition (behavior effect) when the issue was presented by a physically attrac tive endorser. Another credibility component, power, is the commun icator’s coercive ability, or capacity to produce compliance. For communicator po wer to produce and maintain compliance, the recipient must perceive the communi cator as able and willing to administer rewards and punishments and that the com municator will discover and address noncompliance (McGuire, 1969).

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7 Source credibility theory has been applied to the s pokesperson/endorser in tangible goods and service advertising. In this advertising context, the original conceptual definition of the construct has remained relatively unchanged. Trustworthiness is the perceived believability of the endorser; expertise is the perception of a knowledgeable endorser; and attractiveness is perceived attractiv eness and similarity of the endorser to the consumer. In the advertising and consumer behav ior literature, power is not a significant contributor to source credibility (Ohanian, 1991). In contrast with tangible good and service advertis ing, the conceptual definition of the credibility construct is likely to differ when applying the theory to the sponsors of advocacy advertising. Newell and Goldsmith (2001) observed that the credibility of a corporation was similar to, yet different from, the credibility of a spokesperson. For example, physical attractiveness would not apply to corporate credibility, but expertise would. Similarly, a modified construct definition m ay more adequately measure organizational sponsorship credibility of advocacy advertisements (Haley, 1996). In marketing research, credibility scales have been developed in the realm of tangible goods and service advertising. However, no instruments have been developed and applied to advocacy advertising (Figure 2-2). T he current inquiry aims to develop a comprehensive instrument of organizational sponsors hip credibility in the context of an advocacy advertisement. Specifically, the research will address how consumers perceive advocacy advertisement sponsorship credibility and which sponsor, according to this framework, is assessed as the most credible for an anti-importation campaign.

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8 Figure 2-2 Relationship between advertisement types and message sources In addition to benefiting advocacy campaign develop ment as described earlier, the communication and marketing disciplines would benef it if current theory could be supported or enhanced by confirming or challenging the traditional construct definition. Though the original credibility framework was devel oped decades ago, its application, appropriateness, and adequacy to advertising contin ues to be debated amongst researchers (e.g., Ohanian, 1991; Haley, 1996; Newell & Goldsmith, 200 1). Tangible Goods & Service Advertising Advocacy Advertising Spokesperson Endorser Corporate Endorser Organizational Sponsor MARKETING

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9 CHAPTER 3 LITERATURE REVIEW In marketing and advertising research, source credi bility has been studied from many angles and has been treated as both a dependen t and independent variable. The construct has been analyzed as an outcome of advert isement content, format, and delivery (e.g., Newell & Goldsmith, 2001; Smith & Hunt, 1978); as a contributing factor in attitude toward an advertisement and toward the bra nd or action promoted (e.g., Goldsmith et al., 2000; Shamdasani et al., 2001; Zh ang & Buda, 1999); and ultimately as a predictor of consumer purchase intentions (e.g., Gotlieb & Sarel, 1991; Bower & Landreth, 2001). Researchers have studied spokesperson credibilit y, but few have explored sponsor credibility (e.g., Law, 1998; Tybout, 1978; Tse, 1999). Ohanian (1991) examined spokesperson/endorser credibility and co ncluded that the advertising literature identifies three dimensions of source credibility: trustworthiness, expertise, and attractiveness. However, in examinin g the effect of celebrity endorsement, neither physical attractiveness nor trustworthiness was significantly related to purchase intent. Only the respondents’ evaluation of the cel ebrities’ perceived expertise with the product was significantly related to the outcome. T hese results applied to purchases both for personal use and gift-giving—the two scenarios used in the experimental procedure. Ohanian found celebrity and product type match-up ( congruency between the spokesperson and product) appeared to be important when selecting a product endorser. Newell and Goldsmith (2001) examined sponsorship credibility instead of spokesperson credibility. The authors described the development and validation of a self-

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10 report scale (eight items and two dimensions) desig ned to measure corporate credibility. The two dimensions elucidated by exploratory factor analysis were perceived corporate expertise and trustworthiness. Neither attractivene ss nor power emerged as relevant source credibility factors. Construct validity of the corporate credibility sca le was confirmed by correlating it with scales of related constructs like attitude tow ard the advertisement, attitude toward the company, and purchase intent. Newell and Goldsm ith (2001) noted that all correlations with the attitude scales were positive , significant, and consistent with previous studies. Each validation study dealt with corporations that produced and marketed tangible goods (i.e., IBM and Exxon); ther efore, the authors called for future research to include credibility studies in situatio ns where expertise and honesty are especially important. Organizational sponsorship of advocacy advertisements is one such scenario. Haley (1996) used grounded theory, where patterns were drawn f rom the data via induction, to determine the predictors of perceived organizational sponsorship credibility. This approach is in contrast to the hypothetico-ded uctive method in which an a priori theory is superimposed on the data. Individual cons umer interviews were conducted to collect descriptions of what would make an organiza tion an appropriate sponsor for a public service message. The discussion guide encour aged the consumer to speak about personal experiences with advocacy/issue messages. Examples of AIDS and drinking and driving messages were used as probes. Haley’s analy sis confirmed the importance of three of the original credibility dimensions:

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11 Trustworthiness – defined as recognizability, a rep utation of offering a quality product/service, good management, treating employee s with respect, and a history of pro-social involvement with issues. Expertise – defined as being knowledgeable about is sues related to their organization and/or consumers because the organizat ion has a stake in the outcomes. Attractiveness – defined as the personality of the organization and value congruency between the organization and the consume r. Additionally, he found the consumer’s perceptions o f self, society, and the issue were important. Paramount to the credibility assess ment were the specific relationships between the organization, the specific issue and th e consumer (Figure 3-1). Figure 3-1 Haley’s triadic depiction of consumer un derstandings of advocacy messages Essentially, the important factors that emerged in increased perceived organization credibility were: the existence of a logical associ ation between the organization and message, the organization was known, was expert, wa s perceived to be similar to the consumer, was liked by the consumer, was perceived as having good intentions, and was CONSUMER PERCEPTION OF ORGANIZATION Important to society Important to me My action can help Nobody can help I know them I like them They’re like me Congruent with my values CONSUMER PERCEPTION OF SELF CONSUMER PERCEPTION OF ISSUE Logical association Expertise Intent Personal Investment

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12 perceived to have a personal investment in the issu e (Table 3-1). Benefit from sponsorship of the advertisement could not be great er than the benefit to society. Specifically: the trustworthy organization should have personal i nvestment and involvement with the advocated issue beyond words. Consumers we re willing to let the organization benefit from issue sponsorship; howeve r, if the organization was perceived to benefit more than consumers or society from the advocated position, trustworthiness eroded (Haley, 1996). Table 3-1. Haley’s credibility descriptors from int erview transcripts Descriptor Categories Interview Transcript Descript ors I Know Them Recognizable/unrecognizable Familiar/unfamiliar to me Esteemed/not esteemed I Like Them Caring/not caring Humanitarian/not humanitarian Responsible/not responsible Trustworthy/not trustworthy Reputable/not reputable Is/is not good to work for Ethical/unethical Appealing/unappealing Financially responsible/ irresponsible Involved/uninvolved with community Exemplary/not exemplary Is/is not a good product or service They are Like Me and /or They are Congruent with My Values Does/does not understand me Expert/ not an expert with message audience Like/not like me Does/does not share my values Does/does not share my beliefs They are Logically Associated and They are Expert Is/is not an expert with the issue Believable/unbelievable Knowledgeable/not knowledgeable Qualified/not qualified Good/bad match between organization and issue

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13 Table 3-1. Continued Descriptor Categories Interview Transcript Descript ors Intentions and Personal Investment Is/is not well intentioned Compromising/ uncompromising Does/does not care about profit only Sincere/insincere Is/is not invested in issue Is/is not personally involved Issue Importance Important /unimportant issue Important/unimportant to society Important/unimportant to me Our Actions Can Help and No One Can Help Message is/is not a good use of resources Organizations actions can/cannot help My action can/cannot help Issue is/is not solvable In summary, source credibility is an established pr edictor and outcome variable, and while the original construct definition has cha nged over time, the advertising literature has focused mainly on three facets: trus tworthiness, expertise, and attractiveness. This may be due to the difficulty i n operationalizing and measuring power of the communicator over the receiver. Additionally , instruments have been developed and validated to measure spokesperson and corporate credibility in the context of tangible goods advertising; however, a review of the literat ure revealed no scales that have been validated in the context of advocacy advertising. B ased on the richer description of credibility that emerged from Haley’s qualitative r esearch, it is unlikely that the Newell and Goldsmith corporate credibility scale (which on ly measures trustworthiness and expertise) would be an adequate measure of advocacy advertisement sponsorship. Haley (1996) presents the most useful information that relates to the current issue of developing a perceived credibility instrument. H is grounded theory research, by elucidating descriptors for the predictors of perce ived credibility, provides the foundation

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14 for the development of a credibility instruments th at can be applied to organizations that sponsor advocacy advertisements. Hence, the key res earch goals are: 1) to develop a sponsorship credibility scale in the context of adv ocacy advertisements and 2) to determine which sponsor (a federal agency, a pharma ceutical company or a pharmacist organization) is perceived as the most credible spo nsor for an anti-importation campaign using the newly developed instrument.

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15 CHAPTER 4 METHODS Ensuring that an organization sponsoring a campaign is credible and the sponsor and issue are perceived to be congruent by the targ et audience are prerequisites for an effective social marketing campaign. These issues c an be addressed by first determining how sponsorship credibility is understood through q ualitative research, developing an instrument to successfully measure the construct, a nd then applying the instrument to determine the most appropriate sponsor for an antiimportation advertisement. Haley completed the first task by describing consum er’s perceptions of sponsorship credibility via a triad of relationships among the consumer, the issue, and the sponsor. This qualitative research is the basis for the subs equent sponsorship credibility instrument development and application. Instrument Development Rasch measurement, a one-parameter probabilistic it em-response theory model, provides the tools for approximating objective repr oducible additive measures and was used to create a difficulty-ordered equal interval sponsorship credibility scale. Subjects The study sample was composed of English-speaking a dults, 18 years of age and older, residing in the state of Florida. Households were telephoned via random digit dialing. The random digit set was created by the GE NESYS Sampling System and was purchased from Marketing Systems Group, a commercia l sampling firm. The Florida

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16 Survey Research Center at the University of Florida (FSRC) coordinated the sample purchase and administered the telephone surveys. In Rasch analysis, stability of item calibrations a nd the resultant measure are fairly independent of both sample size and test length for rating scale models (Wang & Chen, 2005). While item calibration bias appears with small s amples and short tests, the bias is negligible with the threshold values of 100 subject s and 20 items. Based on Wang and Chen’s (2005) analysis of Rasch model item parameter recovery, standard error estimates, and fit statistics, a sample size of 200 was selected to develop a stable measure of organizational sponsorship credibility. Measure The basic steps for developing self-reported measur es of marketing constructs were adapted to the Rasch methodology (Churchill, 1979). The measurement procedures included: Specifying the construct domains: Haley (1996) provided evidence for the components of organization credibility in the conte xt of advocacy advertising through qualitative research. The item seeds produced from his research along with the domains elucidated in the spokesperson (Ohanian, 1991) and corporate credibility (Newell & Goldsmith, 2001) scales were categorized according to my interpret ation and defined in Table 4-1. Trustworthiness, expertise, attractivene ss, and relevance were the credibility components used as the basis of the new organizatio nal sponsorship credibility scale. Generating a sample of items from literature, surve ys, and insight: The pool of initial items representing credibility were generat ed from the literature and modified through face-to face interviews with eight colleagu es and lay people. Items were developed to capture the credibility construct and were formatted to decrease respondent

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17 burden. Initial items were generated by developing descriptor statements for the continuum of the construct. Table 4-1 exhibits the initial items based on the item seeds generated from Haley’s focus group research. Table 4-1 Item generation from credibility componen ts Credibility Component Item Seed Definitions Initial Items Recognizability – sponsor familiarity to the consumer I recognize the organization. The organization is familiar to me. The organization is likable. Integrity – a reputation of offering a quality product/service The organization provides quality information, services, or goods. The organization is dependable. The organization is competent in what it does. The organization is fair in dealing with the public. Trustworthiness History – a record of prosocial involvement with issues The organization has a personal investment in the issue. The organization is personally involved in the issue. The organization has a reputation of being proactive. The organization is concerned with societal issues. The organization is socially responsible. The organization cares about the community. The organization is involved in the community. The organization is concerned with human welfare. The organization is logically associated with the issue. The organization is consistent on the issue. The organization is sincere regarding its position on the issue.

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18 Table 4-1 Continued Credibility Component Item Seed Definitions Initial Items Trustworthiness Honesty – personal gain with issue is, at most, equivalent with society’s The organization is trustworthy. The organization is honest. The organization is ethical. The organization is moral. The organization is selfless. The organization has good intentions. The organization is unbiased. The organization cares about more than profit. The organization is interested in more than personal gain. Expertise Knowledgeable about issues related to the sponsor’s organization or to consumers Knowledgeable due to a personal stake in the outcomes The organization is knowledgeable about the issue. The organization is experienced with the issue. The organization is expert on the issue. The organization is qualified to speak on the issue. Appeal – likeable personality of the organization I have a good opinion of the organization. Attractiveness Personal Congruence – similar values as message receiver The organization is like me. The organization understands me. The organization understands my situation. The organization shares my beliefs. The organization has values similar to my own. Societal Significance – issue is of importance to society The organization should be involved in the issue. Relevance Practicality – actions can help The organization’s involvement in the issue can help.

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19 Once the thirty-nine initial items were developed, they were reviewed for structure and comprehension by seven colleagues. Each person critiqued a hard copy of the complete survey transcript. The subsequent item mod ifications and additions resulted in forty-five pilot test items which are exhibited in the second column of Table 4-2. Collecting initial data: The credibility items were pilot tested by the Flo rida Survey Research Center and were administered with the gove rnment, represented by the U.S. Food and Drug Administration (FDA), substituted as the potential anti-importation advertisement sponsor. Each item was reviewed for v alidity (face and content) by FSRC staff survey scientists, and the complete survey wa s administered via telephone to eight lay people residing in Gainesville, Florida. The pilot test group comprised six females and two males. Respondent demographics are displayed in Table 4-3. The main i ssues with the pilot test items included redundancy and vocabulary comprehension. A s a result, fourteen items were removed, one added, and eight reworded producing a total of thirty-two items to serve as the basis of the organizational credibility scale. These final thirty-two items were incorporated into the first survey administration a nd are displayed in the third column of Table 4-2. Table 4-2 Organizational sponsorship credibility it em development Initial Items Pilot Test Items First Administration Items I recognize the organization. Had you heard of the organization? Had you heard of the organization before today? The organization is familiar to me. Do you know the purpose of the organization? Do you know the purpose of the organization? Do you understand what the organization does? Do you understand what the organization does? The organization is likable.

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20 Table 4-2 Continued Initial Items Pilot Test Items First Administration Items The organization provides quality information, services, or goods. The organization provides quality drug information to the public. The organization provides quality drug information to the public. The organization helps make quality medicines available to the public. The organization helps make quality medicines available to the public. The organization provides dependable information about the safety of medicines. The organization provides reliable information about the safety of medicines. The organization is dependable. The organization is dependable. The organization is dependable. The organization responds quickly to drug safety issues. The organization responds quickly to drug safety issues. The organization is competent in what it does. The organization is competent. The organization is competent. The organization is fair in dealing with the public. The organization is fair in dealing with the public. The organization is fair in dealing with the public. The organization has a personal investment in the issue. The organization is invested in the issue of importing prescription medications. The organization is invested in the issue of importing prescription medications. The organization is personally involved in the issue. The organization has a reputation of being proactive. The organization is socially conscious. The organization is concerned with societal issues. The organization is concerned with societal problems. The organization is socially responsible. The organization is socially responsible. The organization cares about the community. The organization cares about the American public. The organization cares about the American public.

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21 Table 4-2 Continued Initial Items Pilot Test Items First Administration Items The organization is involved in the community. The organization is concerned with human welfare. The organization is concerned with human welfare. The organization is concerned with human welfare. The organization is against manufacturers importing medications from other countries. The organization is against manufacturers importing medications from other countries. The organization is against people importing medications for personal use. The organization is against people importing medications for personal use. The organization is logically associated with the issue. The organization is clear regarding its position on importing medications. The organization is clear regarding its position on importing medications The organization is consistent on the issue. The organization is consistent regarding its position on importing medications. The organization is sincere regarding its position on the issue. The organization is firm on its position. The organization is trustworthy. The organization is trustworthy. The organization is trustworthy. The organization is honest. The organization is hon est. The organization is honest. The organization is upstanding. The organization is ethical. The organization is et hical. The organization is moral. The organization is selfless. The organization has good intentions. The organization has good intentions regarding its position on the issue of importing prescription medications. The organization has good intentions by sponsoring advertisements about importing prescription medications.

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22 Table 4-2 Continued Initial Items Pilot Test Items First Administration Items The organization has ulterior motives regarding its position on the issue of importing prescription medications. The organization is unbiased. The organization is unbiased regarding its position on the issue of importing prescription medications. The organization is most concerned with the health of the US population. The organization cares about more than profit. The organization is most concerned with profit. The organization is interested in more than personal gain. The organization is most concerned the welfare of the American people. The organization is highly concerned with the welfare of the American people. The organization is most concerned with the welfare of American businesses. The organization is highly concerned with the welfare of American businesses. The organization is most concerned with its own best interest. The organization is highly concerned with its own best interest. The organization is knowledgeable about the issue. The organization is knowledgeable about the issue of importing prescription medications. The organization is experienced with the issue. The organization is experienced with the issue of importing prescription medications. The organization is experienced with the issue of importing prescription medications. The organization is expert on the issue. The organization is expert on the issue of importing prescription medications.

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23 Table 4-2 Continued Initial Items Pilot Test Items First Administration Items The organization is qualified to speak on the issue. The organization is qualified to speak on the issue of importing prescription medications. The organization is qualified to speak on the issue of importing prescription medications. I have a good opinion of the organization. I have a favorable opinion of the organization. I have a favorable opinion of the organization. The organization is like me. The organization understands me. The organization understands my situation. The organization shares my beliefs. The organization has beliefs similar to my own. My beliefs are similar to those of the organization. The organization has values similar to my own. The organization has values similar to my own. My values are similar to those of the organization. I agree with the organization’s position on most issues. The organization looks out for my best interest. The organization looks out for my best interest. The organization is involved in the issue of importing prescription medications. The organization should be involved in the issue. The organization should be involved in the issue of importing prescription medications. The organization should be involved in the issue of importing prescription medications. The organization’s involvement in the issue can help. The organization’s involvement in the issue of importing medications through advertising can help inform consumers. The organization’s sponsorship of advertisements on importing medications can help inform consumers. The organizations involvement in the issue can help protect the welfare of Americans. The organization’s sponsorship of advertisements can help protect the welfare of Americans.

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24 Table 4-3 Pilot test respondent demographics Demographic Frequency Gender Male Female 2 6 Age Category 30–39 40–49 50–59 60–69 70–79 80–89 2 0 1 2 2 1 Race and Ethnicity Black/African American White, Hispanic/Latino White 1 1 6 Education 9th-12th grade, no diploma High school graduate/GED Some college, no degree Associate degree Bachelor degree Graduate/Professional degree 1 0 1 1 2 3 Income < $20,000 $20–34,999 $35–49,999 $50–69,999 $70,000 1 0 1 3 3 Survey administration: The items, with the FDA as the referent organizati on (i.e., the potential anti-importation advertisement sponso r), were administered to the target population until 200 interview completions were rec orded. Data collection occurred Monday through Friday from 5:30 pm to 9:30 pm and S unday 1:00 pm to 5:00 pm. Survey administration began on Monday, March 27, an d ended eleven days later on Thursday, April 6, 2006. The random digit dialing (RDD) sample contained 2,0 00 Florida residential numbers and up to six callback attempts were made f or each. Seventy-three numbers did

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25 not work, were not residential, were non-English sp eaking households, or were nonFlorida resident households and were removed from t he RDD pool. An additional 459 households refused to participate or terminated the interview early, leaving 1,468 usable numbers. A total of 5,832 calls were made by traine d FSRC employees to collect the 200 complete interviews. Refer to Appendix A for the co mplete telephone interview transcript. Editing the measure and assessing item psychometric s with Rasch analysis: The Rasch measurement model computer program, WINSTEPS Version 3.17, was used to create and analyze the psychometric properties of t he credibility scale. Rasch analysis initially converts the raw scores to an interval-ba sed measure called the log-odds metric or logit. This process creates sample-free and test -free measures of perceived sponsorship credibility. The logit scale is based on the natura l log of the odds of an affirmative response (Zhu et al., 1997). The diagnostic statistics generated by the Rasch pr ogram help determine whether the instrument is sensitive in measuring the intend ed population and whether the item difficulties match the person abilities. The determ ination of how well the instrument measures the sample under study is based on the pri nciple that Rasch analysis provides linear measures that estimate the position of each person and item along the same unidimensional, hierarchical continuum (Wright & Stone, 1979). The person separation reliability, analogous to the Cronbach alpha coefficient, and point-biserial item-total correlations were used to assess internal consistency (reliability) of the items. Person separation reliabilities of 0. 7 or greater and minimum point-biserial correlations of 0.3 were considered acceptable for adequate internal consistency

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26 (Nunnally & Bernstein, 1994). Items that did not meet the criteria were droppe d from the instrument. Additionally, items with similar item d ifficulties were reviewed and edited to resolve redundancies and decrease the length of the instrument. The differentiation ability of the instrument was e valuated by calculating the separation ratio or the number of strata in which t he measure separates the respondents. The strata are calculated by using the person separ ation ratio formula (4Gp + 1)/3 , where Gp is the person separation statistic generated by th e WINSTEPS program. A higher number of strata indicates an instrument that is ab le to differentiate among respondents according to ability to endorse/agree with scale it ems. The items were individually examined to determine w hether they fit the hypothesized hierarchy (Table 4-4) and the underlyi ng construct. The hypothesized hierarchy was developed by examining each item and mapping the order of endorsement difficulty or item challenge a priori . Conceptually, it should be easier for respondents to agree with statements regarding recognition of the organization and more difficult to agree with statements regarding the organizations i nherent motives. The hypothesized order evolved from a comparison of each item with t he others to determine its placement along the continuum of credibility construct. The extent to which each item fit the credibility c onstruct was evaluated by item goodness-of-fit statistics. These statistics are te rmed the mean square residuals (MnSq) and were produced for each item of the scale. The M nSq represents observed variance divided by true variance; therefore, the desired Mn Sq value for an item is one. For survey data, ranges of MnSq fit values between 0.6 and 1.4 and associated standardized Z-values (ZStd) less than 2.0 are considered reasonable acco rding to Wright and Linacre (1994).

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27 Table 4-4 Hypothesized item hierarchy from most dif ficult to easiest to endorse Credibility Item Hierarchy Easiest to Endorse > > > > > > Hardest to Endorse The organization’s sponsorship of advertisements on importing medications can help protect the welfare of Americans. The organization is trustworthy. The organization is honest. The organization has good intentions by sponsoring advertisements about importing prescription medications. The organization is against manufacturers importing medications from other countries. The organization is clear regarding its position on importing medications. The organization’s sponsorship of advertisements on importing medications can help inform consumers. The organization responds quickly to drug safety is sues. The organization provides reliable information abou t the safety of medicines. The organization looks out for my best interest. My values are similar to those of the organization. I agree with the organization’s position on most is sues. The organization is highly concerned with the welfa re of the American people. The organization is highly concerned with the welfa re of American businesses. The organization is competent. The organization is fair in dealing with the public . My beliefs are similar to those of the organization . The organization provides quality drug information to the public. The organization is invested in the issue of import ing prescription medications. The organization is qualified to speak on the issue of importing prescription medications. The organization cares about the American public. The organization should be involved in the issue of importing prescription medications. The organization is against people importing medica tions for personal use. The organization is experienced with the issue of i mporting prescription medications. I have a favorable opinion of the organization. The organization helps make quality medicines avail able to the public. The organization is concerned with human welfare. The organization is highly concerned with its own b est interest. The organization is dependable. Do you understand what the organization does? Do you know the purpose of the organization? Had you heard of the organization before today?

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28 A high MnSq value (>1.4) is indicative of variant o r erratic scores and suggests the item does not fit the Rasch model. The item either does not belong with the others on the same continuum or there are problems in item defini tion. A low MnSq value (<0.6) suggests that the item is failing to discriminate i ndividuals with different expressions of the construct or that the item is redundant (i.e., other items measure a similar amount of challenge or endorsement difficulty). Items with hi gher MnSq values (i.e., variant/erratic values) received greater scrutiny because they repr esent a significant threat to validity. Exploratory factor analysis was used to assess the dimensionality of the resultant measure of organizational sponsorship credibility. Collecting new data: The newly developed shortened instrument was then applied to the issue of anti-importation advertisement spon sorship as detailed in the following section. Instrument Application Using the shortened instrument developed with the R asch measurement model, new data were collected. Respondents were asked to use the scale three times, once in turn, with each advertisement sponsor in mind. The most c redible sponsor for the antiimportation message was indicated by the sponsorshi p scenario that produced the highest statistically significant mean measure of perceived credibility. The research hypotheses were: HA1: The Food and Drug Administration will be perceive d as the most credible sponsor. HA2: The Pharmaceutical Manufacturers will be perceive d as the least credible sponsor.

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29 Subjects The study sample was composed of 150 English-speaki ng adults, 18 years of age and older, who were residing in Florida and had a t elephone. As with the first administration, households were contacted via rando m digit dialing from the Florida Survey Research Center. Data collection for the cro ss-sectional survey began Wednesday, June 8, and ended two weeks later on Wed nesday, June 21, 2006. Interviews were conducted Monday through Friday from 5:30 pm t o 9:30 pm, Saturday 11:00 am to 1:00 pm, and Sunday 1:00 pm to 5:00 pm. The instrument development RDD sample contained a t otal of 2,286 Florida residential numbers and up to six callback attempts were made for each. Three hundred and four numbers did not work, were not residential , were non-English speaking households, or were non-Florida resident households and were removed from the RDD pool. An additional 329 households refused to parti cipate or terminated the interview early, leaving 1,653 usable numbers. A total of 6,9 59 calls were made to collect the 150 complete interviews. Refer to Appendix B for the te lephone interview transcript used in the second administration. Analysis Plan All statistical analyses, with the exception of the Rasch analysis, were performed with SPSS 11.5.0 for Windows. Descriptive statistic s were calculated for the demographic variables, including age, gender, race/ ethnicity, education, and income to compare the respondents with the general Florida po pulation according to the 2000 census. As previously mentioned, the most credible sponsor was expected to exhibit the highest perceived credibility measure average. Oneway repeated measures analysis of

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30 variance (ANOVA) was used to compare the mean credi bility measures (the quantitative response variables) across each advertisement spons or (the qualitative explanatory variable). The ANOVA determined whether at least tw o means were unequal. The ANOVA hypotheses were: H0: All means are equal (Government = Manufacturers = Pharmacists) HA: At least two means are unequal Pairwise comparisons of the main effects were made using the Bonferroni confidence interval adjustment to determine which s ponsor(s) were perceived to be the most credible for the anti-importation advertisemen t. The one-way repeated measures ANOVA sample size (N=150) has a 90 percent power to detect an effect if one actually exists, and was calculated with the parameters of =0.01, =0.1, and an effect size of 0.5.

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31 CHAPTER 5 INSTRUMENT DEVELOPMENT RESULTS Two hundred telephone interview completions from ad ult Florida residents were collected over an eleven day period from March 27 t o April 6, 2006. Rasch analysis was used to develop an organizational sponsorship credi bility scale from the 32-item survey administration. Demographic characteristics of the survey sample and comparison statistics from the 2000 census are exhibited in Ta ble 5-1. The gender distribution of the respondents, 53.0 pe rcent female and 47.0 percent male, was similar to the general Florida population according to the state-specific census data. However, the survey sample differed from the general population in other demographic characteristics including age, race, et hnicity, education, and income. Specifically, respondents between the age of 55 and 74 and those with a Bachelor’s degree or higher were over-sampled. Additionally, b lack/African American and Hispanic respondents were under-sampled. Those with a less t han 12th-grade education and an annual household income less than $35,000 were both underrepresented in the survey sample. Overall, 87.0 percent of the respondents had heard about the importation issue in the news media. Although they had been exposed to t he issue, 61.5 percent of the total sample incorrectly believed that it was legal for A mericans to import prescription medications from Canada. Another 13.0 percent were unsure of the legality of importation.

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32 Table 5-1 Descriptive statistics for the instrument development sample Demographic Sample % (N=200) 2000 Census % (N=15,982,378) Gender Male Female 47.0 (94) 53.0 (106) 48.8 51.2 Age Category 18–19 20–24 25–34 35–44 45–54 55–64 65–74 75–84 85 4.0 (8) 2.5 (5) 9.0 (18) 13.0 (26) 16.5 (33) 20.0 (40) 20.0 (40) 14.0 (28) 1.0 (2) 5.8 13.0 15.6 13.0 9.7 9.1 6.4 2.1 Race American Indian/Alaska Native Asian Black/African American White Other 1.5 (3) 0.5 (1) 6.0 (12) 87.5 (175) 3.5 (7) 0.3 1.7 14.6 78.0 3.0 Ethnicity Hispanic Other 6.0 (12) 94.0 (188) 16.8 83.2 Education (age over 25 years) Less than 9th grade 9th-12th, no diploma High school graduate/GED Some college, no degree Associate degree Bachelor degree Graduate or professional degree (N=187) 0.5 (1) 3.7 (7) 19.3 (36) 19.8 (37) 10.2 (19) 27.3 (51) 18.7 (35) (N=11,024,645) 6.7 13.4 28.7 21.8 7.0 14.3 8.1 Income < $35,000 $35,000 < $20,000 $20–34,999 $35–49,999 $50–69,999 $70,000 26.5 (53) 65.0 (130) 6.5 (13) 19.5 (39) 14.0 (28) 14.5 (29) 31.0 (62) 45 55

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33 Rating Scale Performance The Rasch rating scale analysis is graphically pres ented in Figure 5-1. The analysis provides the usage probability of each rating categ ory according to the level of perceived organizational sponsorship credibility expressed in the sample. Respondents with low perceived sponsor credibility would be more likely to use the low end of the scale by more often selecting th e 0-strongly disagree item response. Likewise, those with high perceived sponsor credibi lity would use the high end of the scale indicating that they 5-strongly agree with th e majority of the items. Figure 5-1 plots the rating scale probabilities across the continuum of credibility. For example, a person with low perceived credibility (logit score of appr oximately -2.5) would have a 0.8 probability of selecting a rating of 0-strongly dis agree, and a 0.2 probability of selecting 1-disagree for each credibility item. Similarly, an individual with high perceived credibility (logit score of 4.0) would have an appr oximate probability of 0.7 of selecting 5-strongly agree, and a 0.3 probability of selectin g 4-agree for each item of the scale. The probability curves of the 2-somewhat disagree a nd 3-somewhat agree ratings do not emerge above the other four ratings along th e continuum of credibility. These levels of the rating scale are not being used in th e expected manner. Thus, the rating scale categories were modified by collapsing 2-somewhat d isagree with 1-disagree and 3somewhat agree with 4-agree creating a new four-poi nt rating scale. The performance of the new scale categories are exhibited in Figure 52. With the revision, the probabilities of selecting one of the four ratings are a clear fu nction of the level of perceived credibility expressed by the respondent.

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34 ++------+------+------+------+------+------+ ------+------++ P | | R 1.0 + + O | | B |00 | A | 000 | B .8 + 00 5+ I | 00 55 | L | 0 5 | I | 00 4444444 55 | T .6 + 0 44 4 4 5 + Y | 0 4 44 55 | .5 + 0 1111 4 45 + O | 1*1 11 4 544 | F .4 + 1 00 1 4 55 44 + | 11 0 1 4 5 4 | R | 11 0 13*33333 55 44 | E | 11 0 33* 33 5 44 | S .2 + 11 0 3 4 1 33 55 4+ P | 111 ****2221 5*3 | O |11 22** 440 2** 555 3333 | N | 2222*33 44 000 55***22 33333 | S .0 +********************55555555*00000********* **************+ E ++------+------+------+------+------+------+ ------+------++ -4 -3 -2 -1 0 1 2 3 4 Low Credibility High Credibility PERSON [MINUS] ITEM MEASURE Figure 5-1 Probability of responses for each of the six ratings (0-strongly disagree, 1disagree, 2-somewhat disagree, 3-somewhat agree, 4agree, and 5-strongly agree). The x-axis represents the person measure mi nus the item measure in logits and the y-axis represents the probability of responding to one of the rating categories. ++-----+-----+-----+-----+-----+-----+-----+ -----+-----++ P | | R 1.0 + + O | | B | | A | 4444 | B .8 + 4444 444 5+ I |00 44 44 55 | L | 0 4 44 5 | I | 00 4 4 5 | T .6 + 0 44 44 55 + Y | 0 11111 4 4 5 | .5 + 0 11 11 4 * + O | 1* *1 5 4 | F .4 + 11 0 4 1 5 44 + | 1 0 4 11 5 5 4 | R | 11 0 4 1 5 4 | E | 1 044 11 55 44 | S .2 +1 400 11 5 4+ P | 44 00 11 555 | O | 44 00 11*55 | N | 4444 0000 555555 111111 | S .0 +****5555555555555555555***0000000000000**** ************+ E ++-----+-----+-----+-----+-----+-----+-----+ -----+-----++ -4 -3 -2 -1 0 1 2 3 4 5 Low Credibility High Credibility PERSON [MINUS] ITEM MEASURE Figure 5-2 Probability of responses for each of the four ratings (0-strongly disagree, 1disagree/somewhat disagree, 4-somewhat agree/agree, and 5-strongly agree). The x-axis represents the person measure minus the item measure in logits and the y-axis represents the probability of responding to one of the rating categories.

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35 The rating scale was evaluated according to the gui delines for optimizing rating scale category effectiveness (Linacre, 2002). Measure accuracy, or how well the measure describes the current sample, and measure stability , the element that determines the appropriateness of making inferences from the curre nt sample to another, are functions of rating scale performance. The guidelines delineate essential criteria for optimizing rating scales and thus improving the utility of the result ant measures. As shown in the second column of Table 5-2, each le vel of the revised four-point scale had more than ten observations, an essential criterion for measure stability. Additionally, the essential criteria for measure ac curacy were met. Specifically, the observed average measures advanced monotonically wi th each rating scale category and all outfit mean-square residuals (MnSq) were less t han 2.0. The latter criterion (measures advancing monotonically) was also essential for the rating scale to be adequate in describing the current sample and for the inferenti al value of the scale in future applications. Optimization of the rating scale was also evidenced by two additional criteria that were considered helpful but not essen tial, including step calibrations that were ordered and that advanced monotonically by at lease 1.4 logits and by no more than 5.0 logits. Table 5-2 Four-point rating scale analysis Category Observed Count Observed Average Sample Expected Infit MnSq Outfit MnSq Step Calibration 0-strongly disagree 200 -1.46 -1.49 1.03 1.12 None 1-disagree/ somewhat disagree 1155 -0.55 -0.44 0.90 0.88 -2.73 4-somewhat agree/ agree 3538 0.85 0.80 0.87 0.92 -0.95 5-strongly agree 447 2.55 2.71 1.12 1.02 3.68

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36 Construct Unidimensionality (Item Fit) The extent to which an item fits the credibility co nstruct and the Rasch model is determined by the goodness-of-fit statistics. Overa ll, the 32-item instrument fits the model well. The item separation reliability was hig h at 0.97. Although some individual items performed outside of the acceptable fit range , both the average infit (1.01) and average outfit (1.05) MnSq for the item mean measur e were between 0.6 and 1.4 and the standardized Z-values (ZStd) were less than 2.0 (Ta ble 5-3). Table 5-3 Summary statistics of the thirty-two item instrument Measure Model Error Infit MnSq ZStd Outfit MnSq ZStd Person Mean 0.89 0.39 0.94 -0.6 1.04 -0.3 Std Dev 1.32 0.07 0.66 2.0 0.93 1.5 Maximum 6.27 0.62 3.92 5.8 6.58 4.4 Minimum -2.47 0.28 0.03 -4.3 0.02 -3.5 Item Mean 0.00 0.17 1.01 -0.4 1.05 -0.7 Std Dev 1.14 0.08 0.39 3.2 0.49 3.1 Maximum 1.09 0.52 1.91 6.4 2.14 5.3 Minimum -3.72 0.14 0.50 -5.5 0.46 -5.4 Table 5-4 presents the 32 items with their individu al correlations and calibrations. Highlighted items were omitted from the final 12-it em instrument based on correlations, infit statistics, and overall conceptual contributi on to the construct. Low point-biserial correlations (<0.3) were considered unacceptable fo r adequate internal consistency. Thus, items 1-3, all with correlations less than 0.1, wer e excluded from the final instrument. Seven additional items exhibited a disturbed patter n with high infit MnSq values (items 21–25 and 29–30). These items were 41 to 91 percent more erratic than expected. Conversely, another four items exhibited overly pre dictable, or Guttman-like response patterns, with low infit MnSq values (items 13–15 a nd 17). These eleven items did not fit the Rasch model and were subsequently dropped from the final instrument.

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37 Six items that statistically fit the Rasch model, w ith adequate correlations and infit values, were omitted from the final instrument due to redundancy in the item measure or lack of contribution to the variable. These items a re examined in the following section on item hierarchy and construct validity. Table 5-4 Item calibrations and correlations from m ost difficult to easiest to endorse Item Measure Error Score Corr. Infit MnSq ZStd Outfit MnSq ZStd 17. Beliefs Similar 1.09 0.14 0.74 0.59 -4.3 0.50 -3.9 24. Clear Position 1.05 0.14 0.38 1.44 3.3 1.40 3.3 10. Honest 0.92 0.14 0.72 0.79 -2.1 0.77 -2.0 13. Fair with Public 0.91 0.14 0.71 0.58 -4.4 0.56 -4.2 07. Responds Quickly 0.89 0.14 0.59 0.99 -0.1 0.91 -0.7 18. Values Similar 0.83 0.14 0.63 0.74 -2.4 0.72 -2 .4 11. Trustworthy 0.76 0.14 0.74 0.62 -3.9 0.50 -3.9 20. Experienced 0.76 0.14 0.50 1.16 1.3 1.21 1.5 27. Good Intentions 0.75 0.14 0.72 0.63 -3.8 0.57 3.9 15. My Best Interest 0.73 0.14 0.74 0.50 -5.5 0.46 -5.4 16. Agree with Position 0.65 0.14 0.68 0.65 -3.4 0 .60 -3.6 19. Qualified to Speak 0.54 0.14 0.61 1.09 0.7 1.06 0.5 14. Favorable Opinion 0.54 0.14 0.74 0.54 -4.7 0.51 -4.6 28. Welfare of Americans 0.48 0.14 0.69 0.79 -1.9 0.71 -2.4 12. Cares about Public 0.47 0.14 0.66 0.70 -2.8 0.5 5 -4.1 25. Invested in Issue 0.43 0.15 0.24 1.61 4.0 1.79 4.4 09. Dependable 0.43 0.14 0.62 0.73 -2.5 0.67 -2.8 32. Can Help Protect 0.39 0.14 0.60 0.89 -0.9 0.83 -1.4 06. Reliable Information 0.24 0.14 0.51 1.07 0.6 1. 06 0.4 31. Can Help Inform 0.20 0.15 0.58 0.77 -2.1 0.70 2.4 08. Competent 0.19 0.15 0.66 0.69 -2.8 0.59 -3.5 05. Quality Information 0.04 0.15 0.56 0.91 -0.7 0 .93 -0.5 26. Human Welfare -0.09 0.15 0.62 0.78 -1.9 0.69 -2 .5 23. Against Manufacturers -0.20 0.17 0.40 1.49 3.1 1.49 2.9 04. Quality Medicines -0.27 0.15 0.42 1.26 1.9 1.25 1.7 21. Should be Involved -0.29 0.15 0.56 1.72 4.8 1.70 4.3 22. Against People -0.72 0.16 0.28 1.41 2.8 1.33 2.1 29. Welfare of Manufacturers -1.10 0.16 0.23 1.91 6.0 1.89 5.3 30. Own Best Interest -1.94 0.16 0.06 1.77 6.4 1.84 5.1 03. Understand Function -2.31 0.29 0.09 1.22 0.9 1.62 0.7 02. Know Purpose -2.68 0.34 0.04 1.20 0.7 2.14 1.0 01. Heard of Organization -3.72 0.52 0.06 1.08 0.2 1.64 0.4

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38 Construct Validity (Item Hierarchy) In addition to displaying item calibrations and cor relations, Table 5-4 lists the instrument items in measure order from the most dif ficult to endorse at the top of the table to the easiest at the bottom. Based on the it em measures, the statements that were the most difficult to agree with were 17-my beliefs are similar , 24-is clear regarding its position , and 10-honest. The three easiest items to agree with were 1-had heard of the organization , 2-know its purpose , and 3-understand its function . Several items exhibited identical measures of diffi culty. The similarly performing pairs were 11-trustworthy and 20-experienced , 19-qualified to speak and 14-favorable opinion , and 25-invested in issue and 9-dependable . Item 11-trustworthy was excluded based on redundancy of the measure. The final five items that were dropped from the ins trument (5, 9, 12, 16, and 28) performed well statistically but did not contribute to the measure. A broad range of item difficulties was important for the final instrument . However, contribution to the theoretical construct and the measure as a whole wa s the major determinant of item inclusion. The item hierarchy produced by the Rasch analysis d iffered from the a priori hypothesized hierarchy (Table 4-4). Of note, the it em predicted to be most difficult to endorse, 32-can help protect , was relatively easy to endorse with a measure of 0.39. Likewise, the items 31-can help inform and 23-against manufacturers were much easier to endorse than predicted (0.20 and -0.20, respecti vely). However, the three items with the lowest measures were accurately predicted to be the easiest items to endorse.

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39 Person Fit The respondents, as a whole, fit well with the Rasc h model. Both the average infit (0.94) and average outfit (1.04) MnSq for the perso n mean measure were between 0.6 and 1.4 and the ZStd were less than 2.0 (Table 5-3) . Of the 200 persons that were measured, 92.7 percent of all of their responses we re valid (i.e., were within two standard deviations of the expected response). Individual pe rson calibrations for each of the 200 respondents revealed 99 cases that did not fit the Rasch model with calibration statistics outside of the acceptable range for survey data (0. 6MnSq1.4 and ZStd<2.0). The mean person-ability measure was 0.89 logits gre ater than the mean itemdifficulty measure. The people performed at a highe r level than the items were able to measure; however, the difference in the mean measur es was not statistically significant according to the 1.32 logit standard deviation. Rea l mean person separation reliability was 0.89 and the person separation was 2.82 logits. The 32-item scale divides the respondents into four distinct strata. As previously mentioned, the Rasch model places bot h person ability and item difficulty on the same continuum permitting an asse ssment of how well the instrument measures the sample. Figure 5-3 presents person abi lity on the left side of the continuum and item difficulty on the right. The person-abilit y measures are ordered with those exhibiting the lowest level of perceived sponsorshi p credibility at the top and the highest level at the bottom. The abbreviated items on the r ight are ordered with the most difficult items to endorse at the top and the easiest items t o endorse at the bottom. The items are depicted at their average measure of challenge (i.e ., the measure where they evoke a rating of either 1-disagree/somewhat disagree or 4somewhat agree/agree).

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40 PERSONS MAP OF ITEMS | 7 + | | | # | 6 + | | | | 5 + | | | # | 4 + . | . T| . | . | 3 .# + # | # | .## | ### S|T 2 #### + .#### | ######## | ########## | .###### |S 1 #### + 10 HONEST 13 FAIR WITH PUBLIC 17 BELIEFS SIMILAR 24 CLEAR POSITION .##### M| 07 RESPONDS QUICKLY 11 TRUSTWORTHY 15 MY BEST INTEREST 18 VALUES SIMILAR 20 EXPERIENCED 27 GOOD INTENTIONS ######## | 14 FAVORABLE OPINION 16 AGREE WITH POSITION 19 QUALIFIED TO SPEAK .##### | 09 DEPENDABLE 12 CARES ABOUT PUBLIC 25 INVESTED IN ISSUE 28 WELFARE OF AMERICANS 32 CAN HELP PROTECT .## | 06 RELIABLE INFORMATION 08 COMPETENT 31 CAN HELP INFORM 0 .#### +M 05 QUALITY INFORMATION 26 HUMAN WELFARE #### | 04 QUALITY MEDICINES 21 SHOULD BE INVOLVED 23 AGAINST MANUFACTURERS ###### S| ## | .### | 22 AGAINST PEOPLE -1 ### + 29 WELFARE OF MANUFACTURS .# |S .## | | T| -2 . + 30 OWN BEST INTEREST |T # | 03 UNDERSTAND FUNCTION | 02 KNOW PURPOSE | -3 + | | | | 01 HEARD OF FDA -4 + | Figure 5-3 Relationship between person ability and item difficulty for the instrument. The left side represents person ability measures an d the right represents item difficulty measures, both in logits. Each number si gn represents two respondents and each dot represents one respondent.

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41 The instrument is well matched to the sample under study with the four levels of the rating scale covering the distribution of perso n abilities in the sample. No ceiling or floor effects emerged. The instrument is capturing the range of perceived organizational sponsorship credibility. Credibility Scale Revision As previously discussed, from the original 32-item pool, three items were excluded from the final instrument based on low point-biseri al correlations, seven were removed due to high infit statistics, and four were omitted due to low infit statistics. Another item was deleted due to redundancy in the measure, and f ive were removed due to similarity in phrasing and respondent burden. The remaining 12 it ems created the final organizational sponsorship credibility scale. Table 5-5 exhibits t he item measures and fit statistics from hardest to endorse at the top to the easiest to end orse at the bottom. Table 5-5 Item calibration and correlations for the revised credibility scale Item Measure Error Score Corr. Infit MnSq ZStd Outfit MnSq ZStd 10. Honest 0.57 0.15 0.72 0.93 -0.6 0.80 -1.5 07. Responds Quickly 0.52 0.15 0.65 1.04 0.4 0.91 0.6 18. Values Similar 0.45 0.15 0.63 0.90 -0.9 0.83 -1 .2 27. Good Intentions 0.40 0.15 0.77 0.60 -4.0 0.48 4.3 20. Experienced 0.34 0.16 0.59 1.19 1.5 1.25 1.5 19. Qualified to Speak 0.12 0.16 0.69 1.05 0.4 1.00 0.0 32. Can Help Protect -0.04 0.16 0.67 0.87 -1.1 0.76 -1.7 06. Reliable Information -0.25 0.16 0.53 1.27 2.0 1 .17 1.1 31. Can Help Inform -0.28 0.16 0.61 0.81 -1.7 0.75 -1.7 08. Competent -0.33 0.16 0.62 0.87 -1.1 0.75 -1.7 26. Human Welfare -0.63 0.16 0.65 0.86 -1.2 0.66 -2 .4 04. Quality Medicines -0.88 0.17 0.47 1.48 3.3 1.52 2.8 Performance As expected, the shortened 12-item instrument perfo rmed similarly to the longer 32-item form. The real item separation reliability was high at 0.87 and the persons and

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42 items fit the Rasch model (Table 5-6). Again, altho ugh some individual people performed outside of the acceptable fit range, the average in fit and average outfit statistics for the person and item means were acceptable (0.6MnSq1.4 and ZStd<2.0). Of the 200 people responding to the 12 items, 93.0 percent of all responses were valid (i.e., were within two standard deviations of the expected response). Individual person calibrations for each of the 200 respondents revealed 113 cases that did not fit the Rasch model with calibration statistics outside of the acceptable range for survey data. The mean person-ability measure was 0.52 logits gre ater than the mean itemdifficulty measure, but the difference was not stat istically significant. Real mean person separation reliability, analogous to the Cronbach a lpha coefficient, was 0.80 and the point-biserial correlations were all greater than 0 .3. The person separation was 2.03 logits and the 12-item scale divides the respondents into three distinct strata, one less than the 32-item scale. As with the original instrument, the shortened scal e is well matched to the sample under study and captures the range of perceived spo nsorship credibility with the response categories covering the distribution of person abil ities in the sample. Table 5-6 Summary statistics of the twelve item ins trument Measure Model Error Infit MnSq ZStd Outfit MnSq ZStd Person Mean 0.52 0.72 0.89 -0.5 0.90 -0.5 Std Dev 1.86 0.21 0.80 1.4 0.86 1.5 Maximum 7.07 1.79 6.19 3.2 6.30 3.3 Minimum -4.45 0.46 0.00 -3.1 0.00 -3.1 Item Mean 0.00 0.16 0.99 -0.2 0.91 -0.8 Std Dev 0.46 0.01 0.23 1.8 0.27 1.8 Maximum 0.57 0.17 1.48 3.3 1.52 2.8 Minimum -0.88 0.15 0.60 -4.0 0.48 -4.3

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43 Structure Haley’s (1996) grounded theory research explicated descriptor ph rases for the predictors of perceived organizational sponsorship credibility. These descriptors provided the foundation for the development of the 12-item c redibility instrument in the context of advocacy advertising. The items of the instrument r eflect the triadic relationship between the consumer, the organization, and the issue (Tabl e 5-7). Table 5-7 Sponsorship credibility instrument in rel ation to Haley’s relationship triad Relationship Perceptions Items Self and Organization: I know them I like them They’re like me Congruent with my values The organization provides quality drug information to the public. The organization provides reliable information abou t the safety of medicines. The organization responds quickly to drug safety is sues. The organization is competent. The organization is honest. My values are similar to those of the organization. The organization is concerned with human welfare. Organization and Issue: Logical association Expertise Intent Personal investment The organization is experienced with the issue of i mporting prescription medications. The organization is qualified to speak on the issue of importing prescription medications. The organization has good intentions by sponsoring advertisements about importing prescription medications. Issue and Self: Important to society Important to me My action can help Nobody can help The organization’s sponsorship of advertisements on importing medications can help inform consumers. The organization’s sponsorship of advertisements on importing medications can help protect the welfare of Americans. Between the consumer and the organization, importan t relationship perceptions are knowledge of the organization, its reputation, and congruency between the organization’s value structure and the consumer’s. Between the org anization and the issue, a logical

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44 association and issue investment should exist along with expertise related to the issue and good intent. Between the issue and consumer, the is sue should be perceived as important to the consumer and society and able to be influenc ed by grassroots involvement. Although the goodness-of-fit statistics of the 12-i tem scale suggest a well-defined variable, exploratory factor analysis was employed to further investigate the dimensionality of the resultant measure. Utilizing promax oblique rotation, due to the expected correlation of factors, a simple structure solution was achieved. The items loaded on two main factors, both of which had eigen values greater than one. The scree test, derived from plotting the eigenvalues with th e factors in order of extraction, corroborates the inference that two is indeed the m aximum number of factors to extract (Figure 5-4). These factors together explained 60.1 percent of the standardized total variance. Specifically, the first factor explained 48.6 percent of the variance and the second factor explained 11.5 percent. Factor Number12 11 10 9 8 7 6 5 4 3 2 1Eigenvalue7 6 5 4 3 2 1 0 Figure 5-4 Scree test for the factor structure. The x-axis represents the factor number and the y-axis represents the eigenvalues. The point at which the curve first begins to straighten indicates the maximum number of facto rs to extract.

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45 The first factor encompassed items that related to the character of the organization. As a group, these items refer to the organization’s reputation and similarity to the consumer (Table 5-8). The items that loaded on the second factor were related to the organization’s capability, both in acting on the is sue and making a difference with those actions. Specifically, the second set of items refe r to the organization’s qualifications, motives, and ability to help by being involved. Table 5-8 Credibility items and rotated factor load ings Organization Character Factor Organization Capabili ty Factor Item Loading Item Loading The organization provides reliable information about the safety of medicines. The organization is honest. The organization is competent. My values are similar to those of the organization. The organization provides quality drug information to the public. The organization responds quickly to drug safety issues. 0.868 0.824 0.742 0.721 0.671 0.670 The organization’s sponsorship of advertisements on importing medications can help protect the welfare of Americans. The organization is experienced with the issue of importing prescription medications. The organization is qualified to speak on the issue of importing prescription medications. The organization’s sponsorship of advertisements on importing medications can help inform consumers. The organization has good intentions by sponsoring advertisements about importing prescription medications. The organization is concerned with human welfare. 0.889 0.862 0.769 0.761 0.632 0.532 Similar to previously developed credibility scales, unidimensionality was not supported by the factor analysis. However, the 12-i tem instrument was used as a

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46 conceptual cohesive measure of organizational spons orship credibility and was applied to consumer’s perceptions of advocacy advertisement sp onsors.

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47 CHAPTER 6 INSTRUMENT APPLICATION RESULTS Bias related to the order of the sponsors presented to the subjects was decreased by developing three survey forms for the instrument ap plication administration. Each form exposed an equal portion of the respondents to a di fferent organization in the evaluation of the first sponsor (i.e., a third of the sample r eceived the U.S. Food and Drug Administration (FDA) as the first sponsor under con sideration, another third received the manufacturers, and the final third received the pha rmacists). Fifty completions were collected for each transcript form for a total samp le size of 150. The telephone interviews occurred over a thirteen day period, from June 8–21 , 2006. Descriptive statistics were generated for the sample and Rasch analysis was use d to evaluate the perceived organizational sponsorship credibility of each grou p. Overall, 80.7 percent of the survey sample had hear d about the importation issue in the news media. Similar to the instrument developme nt sample, a large number of respondents (53.3%) incorrectly believed that it wa s legal for Americans to import prescription medications from Canada, and another 1 5.3 percent were unsure of the legality of importing. The respondents differed somewhat from the general Florida population according to the state-specific census data from 2000 (Table 6-1). The survey sample was composed of more females and more respondents with higher ed ucation. However, the sample was similar to the general population according to age distribution, race, ethnicity, and

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48 income. Similar to the instrument development sampl e, the greatest proportion of the instrument application sample was non-Hispanic whit e and well-educated. Table 6-1 Descriptive statistics for the instrument application sample Demographic Sample % (N=150) 2000 Census % (N=15,982,378) Gender Male Female 31.3 (47) 68.7 (103) 48.8 51.2 Age Category 18–19 20–24 25–34 35–44 45–54 55–64 65–74 75–84 85 4.0 (6) 2.7 (4) 6.7 (10) 23.3 (35) 20.7 (31) 17.3 (26) 10.0 (15) 12.7 (19) 2.7 (4) 5.8 13.0 15.6 13.0 9.7 9.1 6.4 2.1 Race American Indian/Alaska Native Asian Black/African American Native Hawaiian/Pacific Islander White Other 2.0 (3) 1.3 (2) 6.7 (10) 0.7 (1) 86.0 (129) 2.7 (4) 0.3 1.7 14.6 0.1 78.0 3.0 Ethnicity Hispanic Other 8.0 (12) 90.7 (136) 16.8 83.2 Education (age over 25 years) Less than 9th grade 9th-12th, no diploma High school graduate/GED Some college, no degree Associate degree Bachelor degree Graduate or professional degree (N=140) 0.7 (1) 6.7 (10) 16.7 (25) 22.0 (33) 14.0 (21) 20.0 (30) 18.7 (28) (N=11,024,645) 6.7 13.4 28.7 21.8 7.0 14.3 8.1 Income < $25,000 $25–34,999 $35–49,999 $50–74,999 $75,000 16.0 (24) 7.3 (11) 18.0 (27) 16.0 (24) 26.0 (39) 22.8 13.7 18.5 21.4 23.6

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49 Five validity-check items were included in the surv ey transcript to verify that the 12-item perceived sponsorship credibility scale did , in fact, measure the credibility construct. After evaluating all of the organization s with the credibility scale, respondents were asked to assess how likely they were to believ e an advertisement sponsored by the FDA, the manufacturers, and the pharmacists (Table 6-2). Additionally, they were asked which sponsor was most appropriate for an anti-impo rtation campaign and which group was perceived to be the most credible overall. Table 6-2 Likelihood of believing advocacy advertis ement content Sponsor Very Likely Somewhat Likely Somewhat Unlikely Very Unlikely Government (FDA) 24.7% 55.3% 13.3% 6.7% Manufacturers 5.3 52.7 24.7 17.3 Pharmacists 31.1 52.7 12.0 4.0 In response to the question regarding appropriatene ss, 47.3 percent of respondents felt that the FDA was the most appropriate sponsor for an advertisement designed to educate consumers about importing prescription medi cations from Canada. Forty-two percent selected the pharmacists and 6.0 percent fe lt that the manufacturers would be the most appropriate sponsor. Additionally, when asked which group was the most credible, 45.3 percent selected the pharmacists, 44.7 percent selected the FDA, and 7.3 percent chose the pharmaceutical manufacturers. Credibility Scale Performance One hundred and forty-eight valid respondent cases were available for Rasch analysis in the FDA sample. Two cases could not be measured and were excluded due to extreme scores. One respondent received a maximum e xtreme score by selecting strongly agree to all 12 credibility items. Likewise, the ot her received a minimum extreme score by strongly disagreeing with every item. Of the 146 cases that could be measured, 94.3

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50 percent of their collective responses were valid (i .e., were within two standard deviations of the expected responses). No minimum or maximum extreme scores were recorded for the manufacturer sample and all 150 cases were included in the measu rement. Overall, 94.0 percent of their responses were valid. In the pharmacist sample, 147 cases could be measured and 91.7 percent of the responses were valid. Three maximum extreme scores (i.e., strong agreement to all items in the scale) were excluded from the analysis. Based on the person mean measures, the pharmacists were perceived to be the most credible organization to sponsor an anti-importatio n advocacy advertisement (Table 6-3). The second most credible was the FDA, and the least credible was the manufacturers. Table 6-3 Mean person measures Sponsor Sample Size Measured Mean Person Measure (SD) Minimum Mean Maximum Mean FDA 148 0.80 (2.00) -4.98 5.11 Manufacturers 150 0.01 (1.84) -4.61 6.05 Pharmacists 147 1.33 (1.99) -2.44 7.56 In the initial Rasch analysis, the item hierarchy c hanged from one sponsor to the next according to the raw item measures (Table 6-4) . The order of item endorsement ease is a factor of the respondent’s perception of the o rganization. For example, 1-quality medicines was the easiest item for the sample to endorse whe n considering the FDA and the manufacturers. However, when evaluating the pha rmacists, 2-reliable information emerged as the easiest item with which to agree. Wh en considering the FDA and the manufacturers, 6-values similar , 5-honest , and 10-good intentions were the most difficult items to endorse. For the pharmacists, the most dif ficult items were 9-qualified to speak , 10-good intentions , and 8-experienced .

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51 Table 6-4 Item measure order Sponsor Item Hierarchy Item Measure Error FDA 6. Values Similar 5. Honest 10 Good Intentions 3. Responds Quickly 4. Competent 12. Can Help Protect 8. Experienced 11. Can Help Inform 9. Qualified to Speak 7. Human Welfare 2. Reliable Information 1. Quality Medicines 1.13 0.49 0.45 0.39 0.16 -0.09 -0.14 -0.27 -0.41 -0.42 -0.62 -0.66 0.17 0.18 0.18 0.17 0.18 0.18 0.20 0.19 0.19 0.18 0.19 0.19 Manufacturers 6. Values Similar 5. Honest 10 Good Intentions 7. Human Welfare 3. Responds Quickly 9. Qualified to Speak 12. Can Help Protect 11. Can Help Inform 2. Reliable Information 8. Experienced 4. Competent 1. Quality Medicines 1.38 1.12 0.99 0.52 0.21 0.13 0.07 -0.03 -0.61 -1.00 -1.10 -1.67 0.16 0.16 0.16 0.17 0.17 0.18 0.17 0.18 0.18 0.20 0.19 0.20 Pharmacists 9. Qualified to Speak 10.Good Intentions 8. Experienced 12. Can Help Protect 11. Can Help Inform 1. Quality Medicines 6. Values Similar 3. Responds Quickly 7. Human Welfare 5. Honest 4. Competent 2. Reliable Information 1.47 1.01 0.92 0.40 0.37 0.09 0.04 -0.39 -0.55 -0.82 -1.00 -1.55 0.18 0.18 0.20 0.20 0.19 0.20 0.22 0.22 0.22 0.22 0.22 0.23 To determine whether the item hierarchies were stat istically different from one organizational sponsor to the next, differential it em functioning (DIF) was examined. The

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52 analysis was performed by calculating the 95 percen t confidence intervals based on the item measure errors and graphing the confidence int erval with the item hierarchies of each sponsor pair to determine which items were sig nificantly different. The first analysis compared the FDA hierarchy with the manufacturer hierarchy (Figure 6-1, top graph). Significant item bias is a pparent in items one, four, five, and seven through ten. When compared to the FDA, the re spondents find it easier to agree that manufacturers provide quality medicines, are c ompetent, and experienced with the issue. Additionally, they find it more difficult to agree, relative to the FDA, that the manufacturers are honest, are concerned with human welfare, are qualified to speak on the issue, and have good intentions. No item bias w as found in five of the twelve items. The second analysis compared the FDA hierarchy with the pharmacist hierarchy (Figure 6-1, middle graph). Significant item bias i s apparent in all items except seven and twelve. When compared to the FDA, the respondents f ind it easier to agree that pharmacists provide reliable information, respond q uickly, are competent, are honest, and have similar values. They find it more difficult to agree, relative to the FDA, that the pharmacists provide quality medicines, are qualifie d to speak on the issue, have good intentions, and can help inform consumers by sponso ring advertisements. No item bias was found in two of the twelve items. The third analysis compared the manufacturer hierar chy with the pharmacist hierarchy (Figure 6-1, bottom graph). Significant i tem bias is apparent in all items except items four and ten through twelve. Overall, the res pondents find it easier to agree that pharmacists provide reliable information, respond q uickly, are honest, have similar

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53 Application Hierarchy Comparison -2 -1.5 -1 -0.5 0 0.5 1 1.5 2 -2-1.5 -1 -0.5 0 0.5 1 1.5 2FDA Hierarchy Manufacturer Hierarchy 10 9 1 2 3 4 5 6 7 8 11 12 Application Hierarchy Comparison-2 -1.5 -1 -0.5 0 0.5 1 1.5 2 -2-1.5 -1 -0.5 0 0.5 1 1.5 2FDA Hierarchy Pharmacist Hierarchy 9 10 11 12 8 7 6 1 5 4 3 2 Application Hierarchy Comparison -2 -1.5 -1 -0.5 0 0.5 1 1.5 2 -2-1.5 -1 -0.5 0 0.5 1 1.5 2Manufacturer Hierarchy Pharmacist Hierarchy 12 1 11 10 2 3 4 5 6 7 8 9 Figure 6-1 Differential item functioning across org anizational sponsors. The item measures for each organization are mapped in order from easiest to endorse at the left of the x-axis and the bottom of the y-axis , to hardest to endorse at the right of the x-axis and the top of the y-axis.

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54 values, and are concerned with human welfare. Addit ionally, they find it more difficult to agree that the pharmacists provide quality medicine s, are experienced with, and are qualified to speak on the issue. No item bias was f ound in four of the twelve items. With evidence of differential item functioning acro ss the sponsors, the instrument development hierarchy was compared to the instrumen t application hierarchies for each of the three sponsors to determine if item bias occ urred from the first survey administration to the second. Figure 6-2 presents t he comparison of the FDA hierarchies in the top graph. Significant item bias is apparent in items four, six, and nine. Specifically, all three items were more difficult t o endorse by the respondents in the second sample (i.e., application sample) than in th e first sample (i.e., development sample). The second group of respondents was less l ikely to agree that the FDA was competent, had similar values, and was qualified to speak on the issue. As expected, differential item functioning is also evident in both the manufacturer and the pharmacist item hierarchies when compared t o the instrument development hierarchy (Figure 6-2). When considering the manufa cturers, the respondents found it more difficult to agree that they were honest, had similar values, were concerned with human welfare, and had good intentions. However, th ey agreed that the manufacturers provided quality medicines, were competent, and wer e experienced with the issue. When considering the pharmacists, the respondents found it harder to agree that they provided quality medicines, were experienced with the issue, were qualified to speak on the issue, had good intentions by sponsoring advertisements, a nd could help inform consumers through advertisement sponsorship. However, they ag reed that pharmacists respond quickly to drug safety issues, provide reliable inf ormation, are competent, and are honest.

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55 FDA-2 -1.5 -1 -0.5 0 0.5 1 1.5 2 -2-1.5-1-0.5 0 0.5 1 1.5 2 Development Hierarchy Application Hierarchy 6 5 10 3 8 1 2 4 9 1 1 2 1 7 Manufacturers-2 -1.5 -1 -0.5 0 0.5 1 1.5 2 -2-1.5 -1 -0.5 0 0.5 1 1.5 2Development Hierarchy (FDA) Application Hierarchy 6 5 4 9 8 7 12 10 1 11 2 3 Pharmacists-2 -1.5 -1 -0.5 0 0.5 1 1.5 2 -2-1.5 -1 -0.5 0 0.5 1 1.5 2Development Hierarchy (FDA) Application Hierarchy 1 2 1 11 10 4 5 3 7 8 9 2 6 Figure 6-2 Differential item functioning across dev elopment and application administrations. The x-axis represents the item mea sures produced with the instrument development sample and the y-axis repres ents the item measures produced by the credibility scale in the instrument application sample.

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56 The graphical illustrations indicate that different ial item functioning is occurring and is likely to be reproduced in continued use of the instrument. The change in item hierarchy within the same scale across the differen t administrations and sponsors can be equated to a ruler with centimeter markings of vary ing length. A measure with this quality does not allow for uniformity and compariso n. Therefore, the item measures were anchored to the original item hierarchy (Table 5-5) revealed in the development of the instrument (with the FDA as the referent organizati on) to control the item bias. After anchoring the items, the Rasch analyses were rerun for each sponsorship scenario, and the person mean measures were compare d to the mean measures produced by the original data set (Table 6-5). The mean meas ure, standard deviation, and minimum and maximum values for each organizational sponsor changed slightly with the anchoring. However, the order of sponsorship credib ility remained unchanged when compared to the unanchored data (Table 6-3). The ph armacists had the highest mean measure, followed by the FDA, and then the manufact urers. The statistical significance of the organizational sponsorship credibility mean mea sures were tested by the subsequent analysis of variance. Table 6-5 Anchored mean person measures Sponsor Sample Size Measured Mean Person Measure (SD) Minimum Mean Maximum Mean FDA 148 0.78 (1.98) -4.92 5.06 Manufacturers 150 -0.04 (1.65) -4.05 5.42 Pharmacists 147 1.17 (1.85) -2.23 6.93 Analysis of Variance One-way repeated measures analysis of variance (ANO VA) was performed with both the original and anchored data to compare the person mean measures produced by the Rasch analysis. All extreme measures were inclu ded in each ANOVA for a total

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57 sample size of 150. A statistically significant dif ference was found between the mean measures for the advertisement sponsors when using the original data set and when using the anchored data set (Table 6-6 ). These results led to the rejection of the null hypothesis that all means were equal. The perceived organizati onal sponsorship credibility mean measure for each of the sponsors was significantly different from all other mean measures. Table 6-6 One-way repeated measures analysis of variance Rasch Data Set Sponsor Sample Size Credibility Measure Mean (SD) F Statistic (p-value) Unanchored FDA 150 0.80 (2.18) 29.03 (<0.001) Manufacturers 150 0.01 (1.84) Pharmacists 150 1.48 (2.24) Anchored FDA 150 0.79 (2.16) 28.04 (<0.001) Manufacturers 150 -0.04 (1.65) Pharmacists 150 1.32 (2.09) Table 6-7 Pairwise comparison of means Rasch Data Set Sponsor Comparator Credibility Measure Mean Difference Pvalue 95% Confidence Interval for Difference Unanchored FDA Manufacturers 0.79 <0.001 0.39 to 1. 18 FDA Pharmacists -0.68 0.008 -1.22 to -0.14 Manufacturers Pharmacists -1.47 <0.001 -1.93 to -1.01 Anchored FDA Manufacturers 0.82 <0.001 0.44 to 1.20 FDA Pharmacists -0.54 0.038 -1.05 to -0.02 Manufacturers Pharmacists -1.36 <0.001 -1.78 to -0.94 All pairwise comparisons of the means were statisti cally significant. Overall, the pharmacists were perceived to be the most credible organizational sponsor with an original mean measure of 1.48 and an anchored mean measure of 1.32 logits (Table 6-7 ). The FDA, the referent group in the development of t he instrument, ranked second in

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58 perceived credibility with an original mean measure of 0.80 and anchored measure of 0.79 logits. Finally, the manufacturers were measur ed as the least credible with an original mean measure of 0.01 and an anchored measu re of -0.04 logits. The responses to the validity-check items that requ ested an evaluation of the most appropriate advertisement sponsor and selection of the most credible organization were compared to the anchored credibility measures. Over all, 56 percent of the respondents had agreement between the sponsor they selected as the most appropriate for the campaign and the sponsor with the highest mean meas ure of credibility. Additionally, there was 60.7 percent agreement between the sponso r selected as the most credible and the sponsor with the highest mean credibility measu re. These results suggest that the 12item organizational sponsorship credibility scale i s capturing the credibility construct as intended.

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59 CHAPTER 7 DISCUSSION Prior to the current research, no credibility scale s had been developed and tested in the unique marketing sphere of advocacy advertiseme nts sponsored by organizations. Ohanian (1991) and Newell and Goldsmith (2001) developed credibility scales in the context of tangible goods advertisements endorsed b y celebrity spokespeople and sponsored by corporations, respectively. However, n either of these scales is adequate for the measurement of organizational sponsorship of ad vocacy advertisements where relationships between the organization, the issue, and the consumer are paramount. By building on Haley’s (1996) grounded theory research, a twelve item instrumen t was developed and validated to measure perceived or ganizational sponsorship credibility. The measure was utilized to determine the most appr opriate sponsor for an antiimportation campaign. The measurement results indic ate that Florida consumers perceive the pharmacists to be the most credible organizatio nal sponsor, followed by the U.S. Food and Drug Administration (FDA), and then the ph armaceutical manufacturers. Instrument Development Rasch analysis was used to develop the organization al sponsorship credibility instrument from a pool of 32 items. This methodolog y was employed to create a standardized difficulty-ordered equal interval scal e that could be translated and adapted to different organization sponsored advocacy advert isement scenarios. The analysis of the 32 items revealed a poorly perf orming 6-point rating scale. However, after collapsing the categories, each of t he four levels became predominant at

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60 some point along the continuum of person abilities. With the new scale, the probability of selecting one of the response categories was a clea r function of the level of perceived credibility expressed by the respondent. According to the average fit statistics, the 32 ite ms fit the model well and represented the credibility construct. Closer scrut iny of the individual item calibrations revealed misfits and poorly correlated items as wel l as redundancy in item difficulties. These factors, along with consideration of responde nt burden and contribution to the measure, were used to shorten the instrument. The resultant 12-item instrument fit the model, cre ated a well-defined variable, and adequately represented the construct based on the a verage fit statistics. The scale was well matched to the sample under study and captured the range of perceived sponsorship credibility with the response categories covering t he distribution of person abilities in the sample Factor analysis was employed to explore the dimensi onality of the 12-item instrument. A simple structure solution was achieve d with two factors explaining the majority of the total variance. The first factor en compassed items that related to the organization’s reputation and similarity to the con sumer. The second factor encompassed items related to the organization’s qualifications, motives, and ability to make a difference in the issue. Similar to the original source credibility framewor k (Hovland, 1953), the organizational sponsorship credibility scale contai ns items that represent expertise and trustworthiness. In contrast to the original framew ork, the new scale includes novel aspects of sponsorship credibility such as issue co ngruence and organization capability

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61 (Haley, 1996). Interestingly, the factor analysis of the 12-ite m instrument grouped the historical credibility domains of trustworthiness a nd attractiveness under the same factor and placed expertise on a separate factor with moti ves and involvement effectiveness. The multidimensionality of the construct was not su rprising given the evolution of source credibility theory and the much-debated doma ins of the credibility construct; however, the factor structure was unanticipated. Ul timately, the scale was treated as a unidimensional measure in the application of the in strument because the items as a whole represent the continuum of credibility and together allow for the comparison of organizations based on a single mean credibility me asure. Instrument Application The 12-item organizational sponsorship credibility instrument was administered to assess the perceived advertisement sponsorship appr opriateness of the FDA, the pharmaceutical manufacturers, and the pharmacists. Item measures produced by the Rasch analysis indicated that the item hierarchy mi ght be shifting across sponsors. Differential item functioning analyses confirmed th e hierarchy variation from sponsor to sponsor and sample to sample. Anchoring of the item measures to the item hierarchy generated in the development of the instrument was employed to control the item bias. The credibility scale produced a mean measure of pe rceived credibility for each sponsorship scenario. The mean measure for the phar macists was significantly higher than both the FDA and the manufacturers in the unan chored and anchored analyses. Contrary to the first alternative hypothesis, the F DA was ranked second in credibility. However, the mean organizational sponsorship credib ility measure of the manufacturers confirmed that they were the least credible of all the proposed sponsors. This finding supported the second alternative hypothesis regardi ng credibility ranking.

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62 When queried directly, the greatest proportion of t he respondents felt the FDA was the most appropriate sponsor for an anti-importatio n campaign and the pharmacists were the most credible overall. Additionally, most were somewhat or very likely to believe the information in an advertisement sponsored by the FD A or the pharmacists. These validity checks corroborated the empirical findings and vali dated the credibility scale. Limitations The use of self-reported data and the population-de pendency of the measure are limitations of the study. Self-reported data is sub ject to validity issues when the participants do not respond truthfully. Such proble ms result when the subjects answer the survey questions according to perceived social desi rability. Measures created with Rasch analysis are test-free and sample-free, but are not population independent. Problems arise when measure s developed with a particular sample are erroneously generalized across all possi ble groups. The measures are population dependent, and those created with the ge neral Florida population may not hold for another group. When administered to a different population, the psychometric properties of the instrument may vary. The differential item functioning evident across th e instrument development sample and the instrument application sample may indicate that the two groups of respondents are from different populations. Both samples did di ffer from the general Florida population according to the census statistics. In t he development sample, respondents between 55 and 74 years and those with higher educa tion were overrepresented and respondents of black/African American heritage, His panic ethnicity, low education, and low income were underrepresented. In the applicatio n sample, females and respondents with higher education were overrepresented.

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63 Implications The Rasch measurement model provides a detailed ana lysis of the psychometric properties of an instrument designed to quantify ad vocacy advertisement sponsorship. Overall, the scale captures the credibility constru ct and allows for the comparison of different sponsorship scenarios. The results contribute to the source credibility li terature by expanding the credibility definition and operationalizing the con struct in a new context (i.e., advocacy advertising organizational sponsorship credibility) . Additionally, the factor structure of the new scale challenges the historical domains of source credibility and suggests a new organization of the credibility components. The new sponsorship credibility measure is not univ ersal. It would be inappropriate to apply these specific items to another advocacy a dvertisement situation where the sponsor provides a good or service unrelated to pre scription medications. However, the measure is translational to other situations by pro viding a model for the development and validation of similar sponsorship credibility scale s. The present research focused on the operationalizat ion of the organizational sponsorship credibility construct and provides soci al marketing campaign developers with new data concerning how consumers assess advoc acy advertisement sponsors. With the new measure, future research is needed to asses s the isolated effects of organizational sponsorship credibility on behavior modification, t he true measure of advocacy advertisement effectiveness.

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64 APPENDIX A INSTRUMENT DEVELOPMENT SURVEY TRANSCRIPT Hello, my name is first name . I'm calling from the Florida Survey Research Cent er at the University of Florida. We are phoning Florida resid ents as part of a study being conducted by a graduate student at the University o f Florida. We would like to understand how people view sponsors of advertisemen ts. This is not a sales call and your answers will be kept confidential. This interview s hould take less than 12 minutes to complete and you may stop at any time. May I please speak with an adult in the household who is 18-years-old or older and has the next birthday? (If time is inconvenient for the person, try to sch edule a time to call back) (RDD sample only includes Florida households) Purchasing prescription medication from other count ries, particularly from Canada, has been discussed in the news. Have you heard about importing prescription medicat ions from other countries in the news media ( on the radio, television, or in the paper )? (Yes, No, Don’t Know, Refused) In your opinion, is it legal for Americans to impor t prescription medications from Canada? (Yes, No, Don’t Know, Refused) The U.S. Food and Drug Administration, or the FDA, is the federal agency that regulates and approves medications, foods, and drug advertise ments. Had you heard of the FDA before today? (Yes, No, Don’t Know, Refused) Do you know the purpose of the FDA? (Yes, No, Don’t Know, Refused) Do you understand what the FDA does? (Yes, No, Don’t Know, Refused)

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65 Please assess the FDA by answering whether you stro ngly agree, agree, somewhat agree, somewhat disagree, disagree, or strongly disagree w ith the following statements. Agree Disagree Items Strongly Agree Somewhat Somewhat Disagree Strongly Don’t Know No Opinion Refused The FDA helps make quality medicines available to the public. The FDA provides quality drug information to the public. The FDA provides reliable information about the safety of medicines. The FDA responds quickly to drug safety issues. The FDA is competent. The FDA is dependable. The FDA is honest. The FDA is trustworthy. The FDA cares about the American public. The FDA is fair in dealing with the public. Next, I will ask about your assessment of the FDA i n relation to yourself. Again, please answer whether you strongly agree, agree, somewhat agree, somewhat disagree, disagree, or strongly disagree with the following statements. Agree Disagree Items Strongly Agree Somewhat Somewhat Disagree Strongly Don’t Know No Opinion Refused I have a favorable opinion of the FDA. The FDA looks out for my best interest. I agree with the FDA’s position on most issues. My beliefs are similar to those of the FDA. My values are similar to those of the FDA.

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66 The US government, represented by the FDA, is inter ested in sponsoring advertisements to educate consumers about importing prescription m edications from Canada. I would like to find out about your opinion of the relationship between the FDA and the issue of importing prescription medications. Again, please use the same response categories and answer whether you strongly agree, a gree, somewhat agree, somewhat disagree, disagree, or strongly disagree with each of the following statements. Agree Disagree Items Strongly Agree Somewhat Somewhat Disagree Strongly Don’t Know No Opinion Refused The FDA is qualified to speak on the issue of importing prescription medications. The FDA is experienced with the issue of importing prescription medications. The FDA should be involved in the issue of importing prescription medications. The FDA is against people importing medications for personal use. The FDA is against manufacturers importing medications from other countries. The FDA is clear regarding its position on importin g medications.

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67 Next, I would like to ask about the FDA’s position regarding importing prescription medications and their motives in sponsoring the adv ertisements. Agree Disagree Items Strongly Agree Somewhat Somewhat Disagree Strongly Don’t Know No Opinion Refused The FDA is invested in the issue of importing prescription medications. The FDA is concerned with human welfare. The FDA has good intentions by sponsoring advertisements about importing prescription medications. The FDA is highly concerned with the welfare of the American people. The FDA is highly concerned with the welfare of American businesses. The FDA is highly concerned with its own best interest. The FDA’s sponsorship of advertisements on importing medications can help inform consumers. The FDA’s sponsorship of advertisements on importing medications can help protect the welfare of Americans. Finally, I have a few background questions for stat istical purposes only. In what year were you born? ______________ (record the year) Gender? (Male/Female don’t ask, just record) Are you Spanish, Hispanic, or Latino? ______________ (record answer) What is your race? (Can select more than one) __American Indian/Alaska native __Asian __Black or African American __Native Hawaiian/Other Pacific Islander __White/Caucasian __Other __Refused

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68 What is the highest level of education you have com pleted? __Less than 9th grade __9th-12th grade, no diploma __High school graduate/GED __Some college, no degree __Associate degree __Bachelor degree __Graduate or professional degree __Refused Is your family’s total yearly income before taxes: __less than $35,000 or __ $35,000 or more __Don’t know __Refused If LESS : and, is that __ under $20,000 or __ $20,000-34,999 __Don’t know __Refused If MORE : and, is that __ $35,000-49,999 __ $50,000-69,999 or __ $70,000 or more __Don’t know __Refused Do you have any questions regarding this study or y our rights as a participant? (Yes or No Refer the respondent to the director o f the survey center or the principal investigator). That completes our survey. Thank you very much for your time and participation . Have a good day/evening.

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69 APPENDIX B INSTRUMENT APPLICATION SURVEY TRANSCRIPT Hello, my name is first name. I’m calling from the Florida Survey Research Center at the University of Florida. We are phoning Florida resid ents as part of a study conducted by a graduate student at the University. We would like t o understand how people view sponsors of advertisements. This is not a sales cal l, your answers will be kept confidential, and you may stop at anytime. This int erview should take less than 12 minutes to complete. May I please speak with an adult in the household w ho is 18-years-old or older and has the next birthday? (If time is inconvenient for the person, try to sch edule a time to call back) (Random-Digit-Dialing sample only contains Florida residents) Purchasing prescription medication from other count ries, particularly from Canada, has been discussed in the news. Have you heard about the importing issue in the new media ( on the radio, television, or in the paper) ? (Yes/No) In your opinion, is it legal for Americans to impor t prescription medications from Canada? (Yes/No) Three organizations are interested in sponsoring ad vertisements to educate consumers about importing prescription medications from Canad a.

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70 The organizations are: 1) The government which is represented by the U.S. Foo d and Drug Administration (FDA), the agency that regulates and approves medic ations, foods, and drug advertisements; 2) The pharmaceutical manufacturers which are represen ted by the Pharmaceutical Research and Manufacturers of America (PhRMA), an o rganization of researchbased companies; and 3) The pharmacists which are represented by the Americ an Pharmacists Association (APhA), the national professional society of pharma cists. Please assess each organization by responding to st atements that relate to the issue and the advertisements. First, please assess the FDA by answering whether y ou strongly agree, agree, somewhat agree, somewhat disagree, disagree, or strongly dis agree with the following statements. Agree Disagree Items Strongly Just Agree Somewhat Somewhat Just Disagree Strongly The FDA helps make quality medicines available to t he public. The FDA provides reliable information about the saf ety of medicines. The FDA responds quickly to drug safety issues. The FDA is competent The FDA is honest. My values are similar to those of the FDA’s. The FDA is concerned with human welfare. The FDA is experienced with the issue of importing prescription medications. The FDA is qualified to speak on the issue of impor ting prescription medications. The FDA has good intentions by sponsoring advertise ments about importing prescription medications. The FDA’s sponsorship of advertisements on importin g medications can help inform consumers. The FDA’s sponsorship of advertisements on importin g medications can help protect the welfare of Americans.

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71 Next, please assess the pharmaceutical manufacturer s by responding to similar statements using the same response categories of strongly agre e, agree, somewhat agree, somewhat disagree, disagree, or strongly disagree. Agree Disagree Items Strongly Just Agree Somewhat Somewhat Just Disagree Strongly The manufacturers help make quality medicines avail able to the public. The manufacturers provide reliable information abou t the safety of medicines. The manufacturers respond quickly to drug safety is sues. The manufacturers are competent. The manufacturers are honest. My values are similar to those of the manufacturers . The manufacturers are concerned with human welfare. The manufacturers are experienced with the issue of importing prescription medications. The manufacturers are qualified to speak on the iss ue of importing prescription medications. The manufacturers have good intentions by sponsorin g advertisements about importing prescription medications. The manufacturers’ sponsorship of advertisements on importing medications can help inform consumers. The manufacturers’ sponsorship of advertisements on importing medications can help protect the welfare of America ns.

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72 Finally, please assess the pharmacists as a group u sing the same categories of strongly agree, agree, somewhat agree, somewhat disagree, di sagree, or strongly disagree. Agree Disagree Items Strongly Just Agree Somewhat Somewhat Just Disagree Strongly The pharmacists help make quality medicines availab le to the public. The pharmacists provide reliable information about the safety of medicines. The pharmacists respond quickly to drug safety issu es. The pharmacists are competent. The pharmacists are honest. My values are similar to those of the pharmacists. The pharmacists are concerned with human welfare. The pharmacists are experienced with the issue of i mporting prescription medications. The pharmacists are qualified to speak on the issue of importing prescription medications. The pharmacists have good intentions by sponsoring advertisements about importing prescription medications. The pharmacists’ sponsorship of advertisements on i mporting medications can help inform consumers. The pharmacists’ sponsorship of advertisements on i mporting medications can help protect the welfare of America ns.

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73 How likely are you to believe the information in an advertisement the FDA sponsors? (very likely/somewhat likely/somewhat unlikely/very unlikely) How likely are you to believe the information in an advertisement the manufacturers sponsor? (very likely/somewhat likely/somewhat unlikely/very unlikely) How likely are you to believe the information in an advertisement the pharmacists sponsor? (very likely/somewhat likely/somewhat unlikely/very unlikely) If an advertisement was broadcast to educate consum ers about importing prescription medications from Canada, which ad sponsor would be most appropriate: the FDA, the manufacturers, or the pharmacists? _________________________ (record answer) Which group is the most credible: the FDA, the phar maceutical manufacturers, or the pharmacists? _________________________ (record answer) Finally, I have a few background questions for stat istical purposes. Where do you get most of your information about pre scription medications? ________________ (record answer) (e.g., doctor, pharmacist, nurse, drug manufacturer , news, internet, library, friends & family, drug advertisements) Do you have insurance? (Yes/No) If YES: Does it cover prescription medications? (Yes/No) Approximately how much do you pay out-of-pocket for your medications each month? ________________ (record dollar amount) In what year were you born? ________________ (record year) Gender? (Male/Female, don’t ask, just record)

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74 Do you consider yourself Spanish, Hispanic, or Lati no? ________________ (record answer) How would you categorize your race? __American Indian/Alaska native __Asian __Black or African American __Native Hawaiian/Other Pacific Islander __White __Other What is the highest level of education you have com pleted? __Less than 9th grade __9th-12th grade, no diploma __High school graduate/GED __Some college, no degree __Associate degree __Bachelor degree __Graduate or professional degree Are you a healthcare professional? (Yes/No) Are you a business owner? (Yes/No) Is your family’s total yearly income before taxes: ______________ less than $35,000 or ______________ $35,000 or more If LESS : and, is that ______________ under $25,000 or ______________ $25,000-34,999 If MORE : and, is that ______________ $35,000-49,999 ______________ $50,000-74,999 or ______________ $75,000 or more

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75 Do you have any questions regarding this study or y our rights as a participant? (Yes/No, Refer the respondent to the director of th e survey center or the principal investigator). That completes our survey. Thank you very much for your time and participation . Have a good day/evening.

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76 LIST OF REFERENCES Agency for Healthcare Research and Quality (2004). Medication Expenditure Panel Survey Statistical Brief #21: Trends in Outpatient Prescription Drug Utilization and Expenditures, 1997–2000 . Retrieved October 5, 2004, from http://www.meps.ahrq.gov/papers/st21/stat21.htm Bower, A. B. & Landreth, S. (2001). Is beauty best? Highly versus normally attractive models in advertising. Journal of Advertising, 30, 1–12. Centers for Medicare and Medicaid Services (2005). National Health Statistics Group National Health Accounts Table 2: National Health E xpenditures Aggregate Amounts and Average Annual Percent Change, by Type of Expenditure: Selected Calendar Years 1980–2003 . Retrieved September 20, 2005, from http://www.cms.hhs.gov/NationalHealthExpendData/02_ NationalHealthAccountsH istorical.asp#TopOfPage Chaiken, S. (1979). Communicator physical attractiv eness and persuasion. Journal of Personality and Social Psychology, 37, 1387–97. Churchill, G.A. (1979). A paradigm for developing b etter measures of marketing constructs. Journal of Marketing Research, 16, 64–73. Goldsmith, R. E., Lafferty, B. A. & Newell, S. J. ( 2000). The impact of corporate credibility and celebrity credibility on consumer r eaction to advertisements and brands. Journal of Advertising, 29, 43–54. Gotlieb, J. B. & Sarel, D. (1991). Comparative adve rtising effectiveness—the role of involvement and source credibility. Journal of Advertising, 20, 38–45. Haley, E. (1996). Exploring the construct of organi zation as source: consumers' understandings of organizational sponsorship of adv ocacy advertising. Journal of Advertising, 25, 19–35. Hovland, C. I., Janis I.L. & Kelley H.H. (1953). Communication and Persuasion . New Haven, CT: Yale University Press. Kaiser Family Foundation and Harvard School of Publ ic Health (2003). Medicare Prescription Drug Survey . Retrieved September 29, 2003, from http://www.kff.org/medicare/po090303package.cfm

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77 Kotler, P. & Zaltman, G. (1971). Social marketing: an approach to planned social change. Journal of Marketing, 35, 3–12. Lane, D. R. (2001). Persuasion Context: Source Cred ibility Theory. University of Kentucky Spring 2001 Communication Theory Workbook . Retrieved October 5, 2004, from http://www.uky.edu/~drlane/capstone/persuasion/sourc ecred.htm Law, S. (1998). Do we believe what we remember or, do we remember what we believe? Advances in Consumer Research, 25, 221–225. Linacre, J.M. (2002). Optimizing rating scale categ ory effectiveness. J ournal of Applied Measurement , 3, 85–106. McGuire, W.J. (1969). The nature of attitudes and a ttitude change. In G. Lindzey & E. Aronson (Eds.), Handbook of Social Psychology (2nd Ed., Vol. 3, pp. 135–314). Reading, MA: Addison Wesley. Meadows, M. (2002). Imported Drugs Raise Safety Con cerns. FDA Consumer Magazine . Retrieved March 20, 2003, from http://www.fda.gov/fdac/features/2002/502_import.ht ml National Association of Boards of Pharmacy (2003). NABP Position Paper on the Importation of Foreign Prescription Drugs . Retrieved March 20, 2003, from http://www.nabp.net/ftpfiles/NABP01/foreigndrug.pdf Newell, S. J. & Goldsmith, R. E. (2001). The develo pment of a scale to measure perceived corporate credibility. Journal of Business Research, 52, 235–247. Nunnally, J. & Bernstein I. (1994). Psychometric Theory. 3rd Ed . New York: McGraw Hill. Ohanian, R. (1991). The impact of celebrity spokesp ersons' perceived image on consumers' intention to purchase. Journal of Advertising Research, 31, 46–54. Patented Medicine Prices Review Board (2003). About the PMPRB . Retrieved March 7, 2003, from http://www.pmprb-cepmb.gc.ca/english/View.asp?x=87 Petty, R. E. & Cacioppo, J. T. (1981). Attitudes and Persuasion: Classic and Contemporary Approaches . Dubuque, Iowa: Wm. C. Brown Company Publishers. Shamdasani, P. N., Stanaland, A. J. S. & Tan, J. (2 001). Location, location, location: insights for advertising placement on the web. Journal of Advertising Research, 41, 7–21. Smith, R. E. & Hunt, S. D. (1978). Attributional pr ocesses and effects in promotional situations. Journal of Consumer Research, 5, 149–158.

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78 Tse, A. C. B. (1999). Factors affecting consumer pe rceptions on product safety. European Journal of Marketing, 33, 911–925. Tybout, A. M. (1978). Relative effectiveness of thr ee behavioral influence strategies as supplements to persuasion in a marketing context. Journal of Marketing Research, 15, 229–242. Underwood, M. (2003). Carl Hovland: The communicato r. Communication, Cultural and Media Studies Infobase . Retrieved October 5, 2004, from http://www.cultsock.ndirect.co.uk/MUHome/cshtml/ind ex.html U.S. Census Bureau. Summary file 1 (SF 1) Florida p rofile of general demographic characteristics. Census 2000 . Retrieved June 20, 2006, from http://factfinder.census.gov U.S. Census Bureau. Summary file 3 (SF 3) Florida p rofile of selected economic characteristics. Census 2000 . Retrieved June 20, 2006, from http://factfinder.census.gov U.S. Census Bureau. Summary file 3 (SF 3) Florida p rofile of selected social characteristics. Census 2000 . Retrieved June 20, 2006, from http://factfinder.census.gov Wang W. & Chen C. (2005). Item parameter recovery, standard error estimates, and fit statistics of the WINSTEPS program for the family o f Rasch Models. Educational and Psychological Measurement , 65, 376–404. Wright, B.D. & Linacre, J.M. (1994). Reasonable ite m mean-square fit values. Rasch Measurement Transactions , 8, 370. Wright, B.D. & Stone, M.H. (1979). Best Test Design: Rasch Measurement . Chicago, Illinois: MESA Press. Zhang, Y. & Buda, R. (1999). Moderating effects of need for cognition on responses to positively versus negatively framed advertising mes sages. Journal of Advertising, 28, 1–15. Zhu, W., Updyke, W.F., & Lewandowski C. (1997). Pos t hoc Rasch analysis of optimal categorization of an ordered-response scale. Journal of Outcome Measurement, 1, 286–304.

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79 BIOGRAPHICAL SKETCH Prior to pursuing graduate education in the Departm ent of Pharmacy Health Care Administration at the University of Florida, Amanda J. Ballentine attended the University of Texas at Austin College of Pharmacy. While at th e University of Texas, she earned a Doctor of Pharmacy degree and received the Outstand ing Student Award for Pharmacy Administration in 2002. Amanda is a practicing comm unity pharmacist licensed in both Texas and Florida. Amanda’s career goals and research interests includ e healthcare policy and pharmaceutical regulation. She has completed projec ts in the safety of computerized physician order entry; physical functioning gender differences in depression; performance measure evaluation of healthcare progra ms; pharmacy student entrepreneurialism measurement; and Canadian intern et pharmacy advertisement design and regulation. Amanda is a University of Florida Grinter Fellow an d member of the Phi Lambda Sigma Pharmacy Leadership Society, Alpha Chi Nation al Honor Society, and Phi Eta Sigma National Honor Society.